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d494b6c0da6c-1 | door to our roller coaster car and we hopped aboard. As the machine
accelerated, the fearful thoughts began to retreat into the background of my
awareness. There was an opening now for more than worry.
I became aware of my son’s liveliness and pure elation. Seeing him throw
his hands up in the air, laughing and smiling. I felt it, too; it was exhilarating
to go against my fearful thoughts. The thoughts were not gone, but I was no
longer a captive of them. I was energized. I was present. I was in the moment.
I was a person who, along with worried thoughts, was having a thrilling,
memorable experience.
Similar to watching an engrossing movie, a particular thought stream has
the potential to pull us in so entirely that there is no “us” separate from those
thoughts. The thoughts become all-powerful, making choices for us, limiting
our experiences, telling us what’s right and what’s wrong. It’s only through
breaking the trance that we can come to see the nature of things as they truly
are.
Our brains supply us with an inordinate number of thoughts, many of
which are unhelpful and even downright inaccurate. Taking each one | anxiety.pdf |
d494b6c0da6c-2 | seriously would be like visiting a beautiful beach and spending the entire time | anxiety.pdf |
a35dc76064e2-0 | counting the grains of sand.
Perhaps
up until this point, you’ve not even considered your thoughts as
anything other than a literal reflection of your reality. When a thought enters,
you take it seriously. You feel it, you worry about it, and perhaps even begin
to plan based on it. Accepting thoughts at face value leads to fusing your
identity with whatever you’re thinking in a particular moment.
There should be a space between you, the observer you, and the thoughts
your mind drops on you. You’re not your thoughts. You’re the leader, the
conductor, the captain—the one who oversees and observes—your thought
stream.
STRATEGY:
BECOME AN OBSERVER
Observing your thoughts and feelings is similar to standing on a high rock to
watch the sea and reflect on its many changes. You notice the ocean waves,
turbulent at times, peaceful at others, and often somewhere in the middle.
From the safety of your rock it’s easy to label what you’re observing. You do
not experience yourself as the changes. You are the one noticing the changes.
Even in a hurricane, the sea eventually becomes calm again. Observe | anxiety.pdf |
a35dc76064e2-1 | yourself. Recognize that even though your brain might be spinning with
various anxiety-based scenarios, it will eventually return to a more peaceful
pattern. And a peaceful brain will inevitably become
unsettled
again. The
feelings or thoughts that dominate the mind moment by moment eventually
evaporate to be replaced by new feelings and thoughts. Such is the nature of
the mind.
1.
Sit quietly. Imagine the observing part of yourself as separate from
your thoughts and emotions.
2.
Notice the direction your mind roams and the accompanying physical
sensations in your body.
3.
Perhaps you notice tension in your chest, sweaty palms, or you have a
headache.
4.
Label these specific sensations without merging your identity or sense
of self with them. For example, “I notice tension and worry coming
over me” as opposed to “I’m a nervous wreck.”
If you keep practicing, you’ll find that thoughts, emotions, and sensations
pass, only to be replaced by others. Calm invariably returns. Your thoughts
will not frighten you when you recognize that they are temporary and not a
direct reflection of reality. | anxiety.pdf |
ed07f12077f0-0 | Go
Deeper
The Anxiety Struggle
Cultivate your capacity for ease and calm by seeing the bigger picture of
how much your struggle with anxiety has come to limit and define you.
Write a paragraph about your anxious identity. How does your struggle
with anxiety influence who you are as a person? How did your anxiety
struggle start and what perpetuated your anxiety over time? How do you
feel your anxiety will hold you back in life? What kind of person do you
see yourself as, as a result of your anxiety struggle?
You can let this struggle go. Consider how your identity would shift if
you were able to better cope with your anxiety.
Write a second paragraph, again with the realities of what you have
endured but this time within the context that you have given up the
struggle with anxiety. You accept your anxiety; it is what it is. At the
same time, imagine you have found ways
to
manage and effectively cope.
You are able to experience joy, be present, and connect with others. What
kind of person would you see yourself as if anxiety no longer dominated
your life?
Our sense of our ability to grow changes depending on how we perceive | anxiety.pdf |
ed07f12077f0-1 | our circumstances. Start seeing yourself as someone who can (like
countless others!) recover from anxiety.
STRATEGY:
TRAIN STATION
This strategy helps you observe and be aware of your experience without
becoming overwhelmed by it.
1.
Imagine yourself safely on an elevated platform in the middle of a
large train station. You have a bird’s-eye view of each track and see
each train as it enters and leaves your station. You see some trains
reenter the station after just a few minutes. Other trains take longer to
reenter, while others don’t come back at all. Some trains stick around
for a bit before they head back out of the station. Other trains leave
immediately after arriving.
2.
Imagine your thoughts as these trains. You are the one safely | anxiety.pdf |
9402816fc607-0 | observing the thoughts come and go. Some thoughts linger, others
leave quickly. You have no control or urgency or job responsibility
around this other than to be aware of your thoughts as you would the
trains entering and exiting the station.
3.
Similar to “red train” or “green train,” see if you can label each train
(thought) as it comes in and out of the station (your mind). Without
judgment or criticism, list in your notebook, or say aloud, the thoughts
that come through your station. See if you can group the thoughts into
larger categories: “worried thoughts,” “catastrophic thoughts,”
“
family
thoughts,” “self-esteem thoughts,” “future thoughts,” or “work
thoughts.” Each time you label a thought as belonging to a certain
category, that thought becomes less persuasive and less significant.
Test Your Predictions
Do you ever wonder why we tend to put our attention more into negative
thoughts than positive ones? Or why we can still remember a critical
comment or upsetting interaction weeks or even years after the event? The
“negativity bias” is the term used to describe the fact that undesirable | anxiety.pdf |
9402816fc607-1 | thoughts, emotions, and interactions have a greater impact on how we feel
than do positive or neutral events. In fact, research shows that people are
much better at remembering negative versus positive things, including angry
versus happy faces, and take more time and mental energy processing
negative events than positive ones. This bias is part of our evolutionary
wiring. From a survival standpoint, the cost of overlooking a negative is far
greater than the cost of overlooking a positive. Consider the early man who
overlooks a bush loaded with edible berries. He will probably survive the
mistake, but if he fails to look over his shoulder to see a stalking wolf pack,
he may not.
You can see how negativity bias helped our ancestors survive. But in
today’s world, when few of us face real threats in our daily lives, this bias can
result in
lots
of needless—and exhausting—worry. When we become overly
anxious, the negativity bias is often the behind-the-scenes culprit. We scan
our environment and ourselves for possible threats and then, without
thoughtful reflection, make improbable forecasts of bad outcomes.
You can break away from the habitually unhelpful ways you see yourself | anxiety.pdf |
9402816fc607-2 | and your world by turning each negative thought into a prediction to be tried
out and tested.
STRATEGY: WHAT’S YOUR ANXIETY | anxiety.pdf |
b495524fa0a0-0 | TELLING YOU?
When you experience anxious thinking, it likely stops you in your tracks
because you take it as a signal or even a command for you to worry and
ruminate. This may be your negativity bias operating at full tilt.
What if the anxious thinking is not a signal to stop and wring your hands
but rather a sign that something you really care about or desire is at stake?
When you recognize you’re making anxious predictions, complete the
following statements to see what might be on the other side of the anxiety for
you and then test out your prediction.
1
.
Write down an anxious prediction (or thought).
Example:
“If I drive, I’ll have a panic attack. Yet I haven’t seen my
mother in a long time. I worry all the time about why I can’t drive. I
also beat myself up for being so weak.”
2.
Write down why this matters to you.
Example:
“I want to visit my elderly mother and spend time with her.
She lives in a nursing home over an hour away, so I have to drive. I’ve
already missed out on so much time with her, but I can’t deal with the
panic.”
3.
Write down strategies that might help you.
Example: | anxiety.pdf |
b495524fa0a0-1 | Write down strategies that might help you.
Example:
Practice progressive muscle relaxation, deep breathing,
guided imagery (imagine driving and being able to cope and arrive
safely). Practice positive self-talk (“I can and I will drive and see her”).
4.
Test out the anxious prediction; see if your hypothesis was accurate.
Example:
“I drove to my mom’s nursing home and I was
uncomfortable but did not lose control and did not have a panic attack
and I got to see my mom!”
Here are specific ways to test common anxious predictions so you can start
working on yours.
WHAT ANXIETY
TELLS YOU
HOW TO TEST IT
I’m afraid the airplane will crash
and I will die.
Practice relaxation exercises, visualization, deep
breathing and then take a flight.
I’m worried about people not liking
me, and being rejected.
Go to a party, work event, neighborhood function, and
try to interact with people. Ask questions; don’t let
yourself recede into a corner. | anxiety.pdf |
b30c8f6da5b3-0 | I’ll never be successful.
Take on a new class, work project, hobby. Build
something, take care of a plant, start a garden.
I’ll never be loved.
Ask family if they love you (it still counts even if it’s
family!). Or become a pet owner; pets provide
unconditional love to many.
The world is against me.
Notice the little things: light traffic, good weather, a kind
person helping you in some way. Catch the world when
it’s being good to you.
I’m useless.
Do something that makes you feel competent: build a
garden, take care of an elderly person or a child, offer to
help someone in your neighborhood, clean your place of
residence, clean your car, plan an activity of some sort
and follow through.
Now
take one of your anxious predictions, remind yourself of why it matters
to you that you work through it, pick a strategy that will help you, and go out
in the world and test it out!
WRAP-
UP
•
Train the voice in your head toward self-compassion and self-acceptance.
•
Replace anxious and negative thoughts with realistic thoughts.
•
Make goals and take actionable steps to lessen anxious rumination.
• | anxiety.pdf |
b30c8f6da5b3-1 | •
Go out in the world, test out your anxious predictions, and see if they’re
accurate. | anxiety.pdf |
d26068fabe02-0 | CH
APTER TEN
Putting the Tools to Work
Whether you’ve struggled with anxiety all of your life, or if this is
your first time, you’ve likely had hopeless moments along the way.
Your anxious thinking may make you doubt your ability to progress.
It’s no wonder you feel this way, because anxiety can become like a
part of your identity, or a shadow you simply can’t shake. Here are
ways to take the strategies you’re reading about and form longer-
term habits that will lead you away from hopeless thinking and
toward the satisfying life you want and deserve.
From
Strategies to Habits
If you continue to cultivate your skills for finding ease and calm when anxiety
is triggered, eventually your anxiety patterns will begin to break, and in the
spaces that open up you can cultivate new habits of thinking and responding.
It’s important to remember that changing the brain’s wiring takes time and
consistent practice. It’s just when we think we can’t take it anymore and want
to give up that we make our biggest gains. Eventually, for longer and longer
periods of time, you’ll forget that you’re practicing healthy coping. Instead,
you’ll enjoy the breeze on your face and the experience of living in this life
now. | anxiety.pdf |
d26068fabe02-1 | now.
Consider what can come if you continue to do this work. Perhaps your
baseline anxiety level, what you feel most of the time, was at a 6 on a 1 to 10
scale (1 is entirely relaxed and 10 is full anxiety meltdown). Once these
strategies become habits you’ll find that your baseline drops, so now perhaps
it is more like a 3 or a 4. This is a marked difference and is the payoff for all
your effort. Once your overall anxiety level decreases, even if only by a few
notches, it will become even easier and faster to successfully challenge
distressing thoughts and repetitive thinking.
Take a moment as you conclude this section to tune into your internal
voice. Is it chastising you that you should do more or reminding you of what
you are doing wrong or criticizing your lack of commitment? Remember, you
do not have to do anything written in
this
book. There is not a “right” or
“wrong” or “should” or “shouldn’t” approach to take you out of your anxiety | anxiety.pdf |
a4198edd828b-0 | struggle. What
will
take you out of it is making a choice for yourself. Do you
want to live in a different way? You would not be engaging these strategies on
any level if the answer wasn’t yes. So make a commitment to yourself to
work on your anxiety each day, no matter how small the effort. When you
miss a day, just pick right back up, no judgment, no criticizing, just pure,
clear, persistent determination.
Planning
Review the planning you started in chapter 4 (
here
) and revised in chapter 7
(
here
). Reconsider how well your planning system is working. Have you
followed through with the plans you made for yourself regarding
implementing the strategies?
Consider adding to your planning approach a couple of reminders each
day on your phone or digital calendar. You might have the reminder “breathe”
in order to stay relaxed and mindful. Or the reminder “positive self-talk” to be
aware of how you’re speaking to yourself in your own head.
Review what you learned in the last two chapters. Identify which
strategies you want to incorporate into your current plan. Try to do your
anxiety work at the same time or times each day. A precise time provides a | anxiety.pdf |
a4198edd828b-1 | cue for the brain that will hasten the “neurons-that-fire-together-wire-
together” process.
Track
Your Progress
One of the most powerful ways to make a new behavior into a habit is to track
what you’re doing. It’s essential to long-term progress that you set up a
system where you track on a daily basis the strategies you’re using, and the
intensity of your anxiety. As we’ve seen previously, you can quickly and
easily track progress with a
chart
you sketch out in your notebook. Take a
look at the example.
STRATEGY
MON
TUES
WEDS
THURS
FRI
SAT
SUN
“Thinking about” vs.
“Experiencing”
✓
Record Your Thoughts
Downward Arrow
Technique
✓
Test Your Core Beliefs
Identify Your Worry
Triggers
✓ | anxiety.pdf |
30fda49b06b7-0 | Probable vs. Possible
Outcomes
✓
Unproductive vs.
Productive Worry
Spot Overgeneralizing
✓
Stop Underestimating
Your Competence
Become Aware of Your
Self-Talk
Pink Unicorns
Replace Negative
Thoughts
✓
Un-Learn Helplessness
Cost-Benefit Analysis
✓
Become an Observer
Train Station
What’s Your Anxiety
Telling You?
Rate Your Anxiety on a
1 to 10 Scale
3
7
9
2
7
5
3
Each day, check any and all strategies you use from
chapters 8
and
9
, or
make a version of this table based on the strategies most useful/applicable to
you. Also, be sure to rate your anxiety, using a 1 to 10 scale, with 1 being
entirely relaxed and 10 being full anxiety meltdown.
Goal
Setting
Struggling with anxiety can feel like fighting the ocean’s current. We spend so
much time working to stay afloat that we don’t have the energy left to focus
on actually getting somewhere. Operating in survival mode has some negative
consequences, especially when it comes to anxiety management. First and
foremost, survival mode doesn’t lead to long-term progress in terms of
consistently escaping the torment of anxiety. Also, survival mode keeps us | anxiety.pdf |
30fda49b06b7-1 | stuck in a mental state where we’re neither fully present nor able to enjoy the
things we cherish most.
Take a break from treading water. Imagine yourself safely on a boat, even
if only for a few moments. From this vantage point, you can observe your
anxiety spiral without becoming entirely engulfed by it. With this perspective | anxiety.pdf |
6fdf92f604cd-0 | in mind, consider your goals for anxiety management:
•
What made you pick up this book?
•
What do you want to achieve?
•
How do you want to feel on the inside?
•
How do you wish you could cope with anxious thoughts?
People
often get to this point and then start to doubt themselves, or talk
themselves out of their goals because they fear it will be too hard to
accomplish, or they’re not strong enough to meet challenging tasks, or they
will fail in the end. Remember, people like you all over the world have
struggled with anxiety and have gotten better. It’s not that they never feel
anxious again, but they find methods to cope in healthy ways and stay present
in their lives. Anxiety is treatable, perhaps more so than any other mental
health problem, and people get better by consistently applying new ways of
thinking and coping.
Setting a goal and sticking to it is akin to spotting and then reaching a
buoy while treading water in the ocean. Each buoy leads to another and
another and before you know it, you see the shore on the horizon. Putting the
effort in and reaching for goals will almost instantaneously help you believe | anxiety.pdf |
6fdf92f604cd-1 | in yourself, increase your self-esteem, and make your anxiety seem less
daunting.
STRATEGY OF THE DAY
Pick a few strategies from this section that you can incorporate on a daily
basis, or a different specific focus each day. One example would be to label a
day “Positive Self-Talk Day,” where you’re mindful of your internal narrative,
or “Identify Errors in Thinking Day,” where
you
commit to focusing on what
exaggerated or irrational thought patterns may be making you feel anxious.
Another helpful strategy is to
“Become an Observer”
of your thoughts each
day. If only for five minutes, commit to watching your thoughts go by without
becoming attached or actively pushing them away.
STRATEGY OF THE WEEK
Pick a few overarching or general strategies that you can work into your
weekly routine at least three times this week. They don’t need to take a
prolonged period of time, just something reasonably achievable for you in the
context of your life. For example, you could incorporate the idea of
“Un-
Learn Helplessness”
, where you commit to taking one reasonable, actionable | anxiety.pdf |
5643b93b7af8-0 | step to combat what is making you anxious. Or commit to a hypothesis test
and use it to challenge at least one of your anxious beliefs.
Go
Deeper
Create Your Weekly Strategies Calendar
Revisit your weekly strategies calendar you created in chapters 4 (
here
)
and 7 (
here
). Take a moment to look over the current month. If you have
not already done so, write in work, social, and family commitments and
appointments.
Habit formation comes faster when we teach our brain new strategies
and techniques on a daily basis. Also, anxiety is reduced when we have a
solid plan and stick to it. Write in one strategy from
chapters 8
and
9
that
you’re willing to employ every day of the month.
Assess what is coming up by digitally or manually marking red, yellow,
and green zones on your calendar. Red zones are those that are more
anxiety charged, green are those where you expect to be fairly at ease
and feel less internal pressure, and yellow are neutral where you imagine
you will feel neither very anxious nor very relaxed.
Take a step back and consider which red zones might trigger anxious
thinking for you. On days or
times | anxiety.pdf |
5643b93b7af8-1 | thinking for you. On days or
times
where you anticipate anxious thinking
or see a red zone, write down a strategy (or strategies) that you think will
be particularly suited for that specific trigger. For example, if you’re
anticipating a few events that will cause you to ruminate or overthink,
consider keeping a thought record that week. Also, if you’re dreading an
encounter, consider if you’re underestimating your competence and
filtering out your abilities and strengths that can help you through the
difficult situation.
Check-
In
For the kind of change that really lasts for the long term, it’s important to
check in with yourself and see how you’re progressing. Otherwise, you may
fall back into those same old anxious habits. Checking in is a way to stay
focused on your goals and to notice which strategies are working or which
you may want to add or change.
Check in with yourself to take stock of what’s going well and also what
you’ve lost sight of on your path to a peaceful life. And as you also take stock | anxiety.pdf |
c222649b530f-0 | of your setbacks, recommit to persevering. Rewiring the brain takes practice
and time.
How Did You Do?
Start by reflecting on how you’re doing every couple of days. Then as you
notice your symptoms improving, check in once a week and then eventually
monthly.
•
How successful were you with your daily goals?
•
How about your weekly goals?
•
Based on the 1 to 10 scale, are you noticing any symptom improvement?
Improvement may be subtle at first, but any reduction in the intensity of your
anxiety, even going from an 8 to a 7, is an improvement. If you weren’t as
successful as
you’d
like, try things differently. Swap out the strategies you’ve
been using for others, and be honest about what’s blocking you from making
more progress. Remind yourself that you want this, and you can and will have
peace of mind and a meaningful life.
STICKING
WITH IT
Any time we make a change or learn something new, we experience
disappointments and obstacles. When you hit setbacks, take a moment to
consider what negative thoughts or beliefs you have about your ability to get
better and start new techniques. | anxiety.pdf |
c222649b530f-1 | better and start new techniques.
For example, you might have the thought, “Doing these exercises will
improve my anxiety,” and simultaneously think, “These exercises are hard, so
I probably won’t get anywhere.” Consider incorporating more realistic
thoughts. For example, “Other people have done this and made themselves
better, so maybe I could change,” or “I don’t have to implement the strategies
all the time or be perfect at it to improve.”
Each day you’re one step closer to your goal of emotional freedom. Don’t
give up. You will come out on the other side of your anxiety. What’s on the
other side? Ease within your
body
and your mind. The kind of ease that will
enable you to steadily push out of your comfort zone so you no longer miss
out on all life has to offer. You can and will achieve, connect, and live a fully
present life.
Reading about the strategies means you’re no longer resigning yourself to an
anxious life. This change alone, of giving yourself new ways of thinking and
managing your anxiety, perhaps more than any other, will deliver the peace | anxiety.pdf |
04f13176d905-0 | and calm you deserve. Now keep going. Don’t give up; you’ve already come
so far. | anxiety.pdf |
6321573cef83-0 | What
You’ll Learn in This Section
Recognize that you do have the ability to manage your anxiety and
experience the kind of ease and calm you want. This confidence
doesn’t have to come all at once. However, it’s something we’re all
capable of building, and this section addresses how to stick with the
strategies for the long term. One element is learning to celebrate
your successes. Recognition of progress, even when it comes in
very small increments, fuels your ability to be persistent, and
persistence is the path to new learning. We will also look at how to
sidestep the negativity bias, nip anxiety in the bud, and clarify
which strategies you want to maintain throughout your life. And we
will explore ways to accelerate your progress on the anxiety-
reduction path—including building your support network,
psychotherapy, and medication. | anxiety.pdf |
4f519be56a2f-0 | CH
APTER ELEVEN
The Road Ahead
Long-Term Outlook
It is estimated that one in five adults in the United States meets the diagnostic
criteria for an anxiety disorder. As prevalent as anxiety is, it is also highly
responsive to treatment. But how can we tell who will get better and who
won’t? Well, I see it consistently in my practice, and research backs this up:
When people adopt these three “beliefs” they typically are able to learn,
sooner rather than later, to manage their anxiety symptoms.
1.
Believe you need to change:
Doing the same things you’ve always
done keeps you stuck. Open yourself up to new ways of thinking and
behaving and you’ll start changing.
2.
Believe in the strategies:
Self-doubt and second-guessing the process
is only a distraction from building the new habits that will take you
away from anxiety and toward greater calm. The strategies in this book
are all evidence based,
which
means research has proven their
effectiveness. The strategies work, they really do!
3.
Believe in your ability to grow:
As we’ve seen, people just like you | anxiety.pdf |
4f519be56a2f-1 | As we’ve seen, people just like you
all over the world experience anxious patterns yet find sustained peace
of mind, so why couldn’t this be you? Believe in yourself, and you will
gain control over your anxiety.
Your Biggest Victories So Far
Take a moment to remember what emotions and habits were ruling you before
you read this book. Now, like playing back a reel of sports highlights, look at
your greatest victories so far. Perhaps you couldn’t connect with your other
emotions, except for anxiety, and now you’re no longer afraid to look under
the anxiety and understand what you’re really feeling. Or perhaps you’ve
found ways to relax your body and not feel as physically keyed up.
Maybe you’ve stopped avoiding something, or a few things, that have
long caused you fear and apprehension. Maybe the concept of acceptance,
that anxiety is a part of human experience, has opened up space so there’s a
“you” now separate from being anxious.
Or maybe you’ve found ways to become unstuck from or challenge your | anxiety.pdf |
ae4f24174ba5-0 | fearful and anxious-thought patterns. You may even have moments now
where you’re able to observe your thoughts or feelings without becoming
overwhelmed by them.
If
you’re thinking about your struggle differently, if you’re engaging new
ways of thinking or behaving, consider yourself victorious. Now keep on
doing what’s working.
Your Biggest Challenges So Far
What have been your biggest challenges so far? Perhaps you continue to
struggle and have not yet seen any noticeable benefit. Or perhaps the
improvements feel too small and not impactful enough.
It can feel impossible to keep believing in yourself and your treatment
approach when you’re not noticing any measurable change. Take a firm look
at the facts.
•
Are you following the strategies?
•
Do you believe the strategies will work?
•
Do you believe in yourself and your ability to improve and live the life you
deeply desire?
Also, consider if there are specific strategies, or even entire sections of the
book, that you find particularly challenging. Reflect on what has been the
hardest for you to accept, to take in, and to change. Consider whether you | anxiety.pdf |
ae4f24174ba5-1 | might benefit from additional support to help you with the rougher patches
(more on therapy and medication in
chapter 12
). Give yourself compassion
for going toward what’s difficult, and for not giving up.
The
Road to Progress Isn’t Always Straight
Change doesn’t unfold in a straight line, although we often believe it should,
which is why when we confront setbacks we become self-critical and start to
doubt ourselves. This kind of thinking sabotages progress and contributes to
us giving up entirely.
The reality is that setbacks and failures along the path to change are
inevitable for everyone. Our brains have the miraculous ability to rewire, to
grow, to change; however, our brains also cling to what’s become habit. This
contradictory tension means change does not come immediately or without
effort. Sustained change, the kind that really makes a difference, takes time
and consistency.
Each time you hit a roadblock, instead of self-criticism and self-defeat, | anxiety.pdf |
82da67c7e8a5-0 | consider the roadblock a signal of your growth and progress. After all, if you
were still stuck doing what you’ve always been doing, you wouldn’t have
come across a roadblock. When progress on the anxiety-reduction trail stalls,
or even halts completely, it means you’ve likely progressed, more than you
imagined, and that’s why the setback bothers you. Setbacks are part of your
brain’s adjustment process. Keep persisting, don’t give up, and return to the
strategies again and again. It will pay off.
Go
Deeper
Gratitude
Recognizing what we’re thankful for increases well-being, contentment,
and peace of mind. The negativity bias, as we’ve seen, is wired into our
brain as a survival mechanism. We tend to dwell on, relive, and attempt
to problem solve the negative more than the positive. When this process
isn’t buffered by joy or contentment, we become more anxious.
We can counter the negativity bias easily and in only a few minutes a
day. Adopt a daily practice of identifying two or three things that you
appreciate. You can write these in your notebook or internally reflect on
them. What’s important is to bring conscious and deliberate attention to | anxiety.pdf |
82da67c7e8a5-1 | what is going well, or at least okay, in your life or what you feel
positively about within yourself.
Building
Your New Habits
Once you’ve been successful with a strategy, take it to the next level. Practice
the strategies on multiple occasions across a variety of settings.
For example, if you fear eating out in public, don’t decide to just go to the
same restaurant with the same friend over and over. Instead, challenge
yourself to go to a variety of restaurants and with a variety of people. It’s
great to become comfortable knowing that you’re no longer going to have a
panic attack in your local movie theater, but consider branching out to other
theaters in nearby towns or even going to a play or a concert. Or if you’re
working on obsessive thinking, don’t just work on it when you’re at your
place of employment. Work to be mindful, an observer, when home alone,
when driving, even when interacting with others. Practice the strategies across
a variety of situations/people and you’ll eventually start using them
instinctively.
The more you act the way you wish you could act, and do the things you | anxiety.pdf |
c632b1aade08-0 | used to avoid, and think in the ways that bring peace of mind, the quicker new
habits will form and then, before you know it, they’ll become automatic.
Exercise: Catch Anxiety Early
Catch anxiety early, before it’s left the barn, so to speak, and you’ll stop it in
its tracks before it becomes too intense to pull back. A way to start catching
anxiety
early
is to develop a quick and easy habit of checking in with
yourself. So instead of rushing from task to task, person to person—
intentionally STOP. Take time to be mindful of your ongoing experience.
Here’s how:
•
At the end of the day when you arrive home, STOP before entering. Reflect
for a few moments; check in with yourself.
•
When you end one encounter, STOP. What’s going on in your body, your
mind? What sensations do you notice?
•
When you finish a task, STOP. Reflect on what tinges or shifts might be
happening mentally or physically for you. Literally say to yourself, “I want
to see you. What’s going on in there?”
Tune-Ups and Check-Ins
As you move along your anxiety-recovery path, you may find there are | anxiety.pdf |
c632b1aade08-1 | stretches of time when you’re no longer deliberately thinking about the
strategies. You may feel that you’re “in the zone,” able to effortlessly manage
life’s hardships.
Still, even with progress, it’s easy for us to go back to old ways of
thinking and acting. Consider placing sticky notes in key locations (car,
bedroom mirror) or reminders on your digital calendar of the strategies that
are working well for you so you keep them top of mind and use them even
when you may not feel like you need
them.
Also, set a reminder on your
calendar once or twice a month to review the material in this book and what
you’ve written in your notebook (even if you think you don’t need to!).
Goal Setting
Each time you reach a goal, consider the strategies that got you there and if
it’s possible to expand those strategies to reach even larger goals. For
example, perhaps you implemented “total worry time” (
here
) and it worked.
Now that you’ve discovered its effectiveness, consider making it a goal to do
this strategy on a daily basis. Or if you recognize that
“Watching Your
Thoughts”
works when under stress, consider implementing this strategy | anxiety.pdf |
c632b1aade08-2 | works when under stress, consider implementing this strategy
every day while driving to work, with or without stress. | anxiety.pdf |
a69efc083cf5-0 | Once your overall anxiety level decreases, you’ll likely find that you think
about your goals in new ways and find deeper, more meaningful, ways to
impact your life. And as your well-being increases, the overall picture of the
path forward will no longer bring dread but instead pleasure and optimism.
You have much to look forward to!
Exercise:
What’s the Big Picture?
Refocus on the bigger picture in which overall strategies are important to you
in maintaining your less-anxious life. These are the strategies that either
worked well for you, or are linked to something you care about, like an active
social life. Here’s a list of some of the things my clients keep in mind. Make a
list of your own.
•
Physical exercise
•
Daily mindfulness
•
Physical health
•
Live your best life
•
Acceptance
•
Challenge your thoughts
•
Exposure
•
Make space for yourself separate from your anxious thoughts | anxiety.pdf |
04f77bafdd80-0 | CH
APTER TWELVE
Building Your Support Network
Human connection relieves anxiety. Looking another person in the
eye and sharing our vulnerable moments, aspirations, and setbacks
soothes our nervous systems. If you’ve been caught in anxiety’s grip
for some time, you may not have had the mental space to sustain
close family or friendship ties. One-on-one meetings with a
therapist or group therapy are ways to start garnering some in-
person support. Online anxiety-reduction tools also can be helpful.
Sharing your goals, progress, and setbacks with others offers a
sturdy brace that will give you encouragement and perspective as
you find your way.
Finding
a Therapist
Be Calm
is for you to use on your own, or with a therapist if you have one.
You can find relief on your own if you’re persistent and stay with it. However,
you will want to participate in psychotherapy if you’d like to accelerate the
learning process, deepen your self-awareness, if you have little social support,
or if you’ve implemented the strategies and are not feeling much relief or
progress.
Psychotherapy in a sense is a mini laboratory where you can try out your | anxiety.pdf |
04f77bafdd80-1 | new skills with another human in real time. Unlike your “real” life, the
therapeutic life is safe and confidential, and the therapist has no connection
with your outside relationships or broader life.
Often, working with a therapist can be tremendously effective in
understanding yourself and in developing a support network outside of
therapy. The past, in particular unprocessed grief and trauma, has a significant
impact on the persistence of anxiety symptoms. Consider weekly
psychotherapy to help you work through past trauma and loss that may be
impacting your ability to feel sustained relief from anxiety.
As we’ve seen, anxiety frequently masks other negative emotions that you
may be unaware of or have not yet processed. Talking with a therapist can
help you uncover those negative emotions and identify what’s causing them.
Very typically, anxiety lifts when you enter therapy and start the process of | anxiety.pdf |
68bcf16d4b98-0 | exploring your deeper emotions and issues. You may be faced with
other
complicated emotions, but awareness of them will significantly accelerate the
recovery process.
Medication
In some cases, medication along with psychotherapy is the best approach for
anxiety reduction. This should be considered only after using the strategies in
this book on a consistent basis and meeting with a licensed mental health
therapist or clinical psychologist. If you and your therapist believe medication
could be helpful, set up an appointment with a psychiatrist. Psychiatrists have
specific training in how drugs impact emotions and behavior.
If you decide to try medication, be wary of benzodiazepines and
prescription painkillers (including Xanax, Ativan, and
Clonazepam/Klonopin). Benzodiazepines and sedatives work right away to
bring down anxiety, which provides relief in the moment, but over time it’s
easy to become dependent on them. Also, if you use sedating medication you
will be unmotivated to implement the strategies and your brain will be less
able to retain the new ways of dealing with anxiety. And there is a rebound
effect when benzodiazepines and painkillers wear off. Anxiety typically | anxiety.pdf |
68bcf16d4b98-1 | comes roaring back in, even stronger, and then you’ll feel the immediate need
for more of the drug.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-
norepinephrine reuptake inhibitors (SNRIs) are generally more effective for
anxiety reduction over
the
longer term. However, it’s essential that you
undergo a full assessment with a psychiatrist for an accurate diagnosis and
appropriate medication regime.
Getting Referrals
Accessing support, whether with a psychologist, a psychiatrist, or a support
group, is a way to enhance your recovery process as you move toward your
goal of anxiety reduction. Often, a good place to start is with your general
practitioner. Talk to your medical doctor about your symptoms and see if they
can refer you to a psychotherapist or clinical psychologist.
Online search engines can also be quite helpful in getting a referral. The
Anxiety and Depression Association of America website has a “Find a
Therapist” link that will connect you with licensed mental health providers in
your geographical area who specialize in the treatment of anxiety. Some of
the listed mental health professionals also provide telemental services (online
therapy) through video conferencing, phone, or email. | anxiety.pdf |
68bcf16d4b98-2 | therapy) through video conferencing, phone, or email.
The Social Anxiety Institute website also provides a referral list of | anxiety.pdf |
a3fdd6b3f74d-0 | treatment providers as well as other resources for lessening social anxiety.
The American Psychological Association, a professional organization for
psychologists, has an online tool to find a psychologist near you, as does
Psychology Today
where you can read various therapists’ profiles to see who
might be a good fit.
When
searching for a therapist to help you with anxiety symptoms, look
for those who are licensed mental health providers or licensed clinical
psychologists who specialize in cognitive behavioral therapy, mindfulness,
and/or acceptance and commitment therapy. As we’ve seen, these approaches
are well researched and have shown to be effective in the treatment of anxiety
disorders.
Online Support
Working on the strategies in a vacuum with no outside influence will not be as
effective as if you share what you’re doing with the outside world. Whether
you talk with trusted friends or family or seek online support makes little
difference. However, finding a way to connect with others who also struggle
can help you feel more normal and keep the material fresh in your mind.
The National Alliance on Mental Illness (NAMI) is one of the leading
mental health organizations in the United States. NAMI supports, advocates, | anxiety.pdf |
a3fdd6b3f74d-1 | and educates on behalf of the mentally ill and their families. The NAMI
website offers support regarding a range of mental health experiences, as well
as what it is like to live with the stigma of mental illness.
The Anxiety and Depression Association of America has an online
anxiety and depression support group where you can connect with people all
over the world who cope with anxiety. You can join this group anonymously
through the online app or through subscribing.
One
positive step to take is to
sign up and simply peruse ongoing conversations to help you feel connected
to others struggling with similar symptoms. Over time, you may become more
and more comfortable initiating your own discussions.
The National Suicide Prevention Lifeline (1-800-273-8255) provides free
confidential support, 24 hours a day, seven days a week for people in crisis
and in need of immediate intervention.
Support Groups
Group therapy is extremely effective in lessening anxiety symptoms. In fact,
for some people, group therapy is more impactful than individual therapy.
Group therapy works because it challenges our ideas that we’re alone in our
suffering and are somehow “bad” or “less than” others as a result. This | anxiety.pdf |
99b31a39fcf3-0 | experience reduces shame and isolation and also helps with the idea of
accepting anxiety while you continue to live your life.
Communicating and connecting in a group therapy setting often helps
people develop self-awareness around their role(s) in social relationships.
While in the group, a person may act out a role that they use to manage their
anxiety in real life, i.e., overly friendly, withdrawn, very inquisitive,
constantly talking, dismissive. Group members typically reflect on the roles
they notice and provide one another with feedback. Because group therapy is
not real life and is confidential, it feels safe for people to
process
such
feedback. As a result, they become more flexible or even adopt other roles in
the group that will eventually extend to their real-life relationships.
In addition, when we’re in an anxious state, adrenaline can take over. It
can be hard to know what we feel deep down, let alone find the words to
express what we’re feeling. Yet, anxiety typically decreases when we’re able
to talk with others. Group therapy is a type of exposure in that you’ll probably
feel anxious at moments. At the same time, it’s a nonthreatening place for you
to become more skillful at knowing what you’re feeling, when you’re feeling | anxiety.pdf |
99b31a39fcf3-1 | it, and becoming comfortable expressing it.
Finding a Group
If you decide that group therapy is a treatment approach you’d like to try, and
you have an individual therapist, consider asking your therapist if they know
of a group that would be a good fit for you. Alternatively, there is a “Find a
Support Group” feature on the Anxiety and Depression Association of
America website as well as the
Psychology Today
website.
Keep in mind there are two common types of group therapies. “Process-
oriented” groups are led by a therapist, but generally the therapist lets the
group members steer the discussion. Process groups are about the group
members’ experiences of what they’re observing, feeling, or want to discuss.
“
Psychoeducational” groups also are led by a therapist but the therapist
takes on an instructor role. Psychoeducational groups are helpful when you’re
looking to gain specific skills in some area of your life or functioning. In this
case an anxiety psychoeducational group might discuss coping skills and
strategies.
Starting a Group
As we’ve seen, anxiety is an extremely prevalent issue for many people. If
you’re looking for an anxiety therapy group in your local area and can’t find | anxiety.pdf |
99b31a39fcf3-2 | one, chances are others are, too. | anxiety.pdf |
0aef3c9ffcb7-0 | If you decide to start a group, think carefully about how you wish to
structure it, what kinds of members you’re targeting for the group (only
anxiety, anxiety and other mood issues, relationship issues), and who will be
the leader. Consider if you want this to be a process-oriented or more of an
information-sharing group. It’s also important to think through group therapy
rules. It’s typically helpful not to have a group with family members or people
who know one another very well because it reduces anonymity and the
comfort that comes from anonymity. Confidentiality among group members is
key to feeling safe and open, which is what helps people grow.
Staying
the Course
Like many things in life, success in your pursuit of anxiety reduction and
internal peace takes patience, adaptability, and perseverance. Of course,
anxiety is unpleasant and you’d like it to stop as quickly as possible.
However, habits take practice to form and they take practice to break.
Compassionately remind yourself that there’s nothing wrong with you if you
feel that your recovery isn’t moving as fast as you’d like. And just because
it’s taking time doesn’t mean you won’t get better.
Allow yourself to adjust the strategies for your personal brand of anxiety | anxiety.pdf |
0aef3c9ffcb7-1 | symptoms. One strategy may work for a while, but it’s important to try new
ones so you stay challenged and keep growing. As your symptoms improve,
the anxiety will likely change and present itself differently. You will need to
adjust and bring new skills into your repertoire. If the strategies aren’t
working or are going only so far, then consider individual psychotherapy or
group therapy. Some people do both. If therapy doesn’t work on its own,
consider combining psychotherapy and medication.
And, most importantly, whatever you do, don’t give up! Allow yourself to
pick the work back up again and again. Believe in the process. Your work will
pay off in the form of a brighter future. | anxiety.pdf |
2583c71b54ea-0 | Resources
Online
Anxiety and Depression Association of America (
adaa.org
)
Social Anxiety Institute (
socialanxietyinstitute.org
)
American Psychological Association (
apa.org
)
National Alliance on Mental Illness (
nami.org
)
National Suicide Prevention Lifeline (1-800-273-8255)
Headspace:
Meditation app
Calm:
Meditation and sleep app
Further Reading
Antony, M. M. and Swinson, R. P. (2009).
When Perfect Isn’t Good Enough:
Strategies for Coping with Perfectionism
. Oakland, CA: New Harbinger.
Bourne, E. J. (2015).
The Anxiety and Phobia Workbook
(6th ed.). Oakland,
CA: New Harbinger.
Carbonell, D. A. (2016).
The Worry Trick: How Your Brain Tricks You into
Expecting the Worst and What You Can Do About It
. Oakland, CA: New
Harbinger.
Collard, P. (2014).
Little Book of Mindfulness: 10 Minutes a Day to Less
Stress, More Peace
. Colorado: Gaia.
Hanh,
Thich Nhat. (1999). | anxiety.pdf |
2583c71b54ea-1 | Hanh,
Thich Nhat. (1999).
The Miracle of Mindfulness: An Introduction to the
Practice of Meditation
. Boston: Beacon Press.
Hayes, S. C. (2005).
Get Out of Your Mind and Into Your Life: The New
Acceptance and Commitment Therapy
. Oakland, CA: New Harbinger.
Knaus, W. J. (2014).
The Cognitive Behavioral Workbook for Anxiety: A Step-
By-Step Program
(2nd ed.). Oakland, CA: New Harbinger.
Pittman, C. M. and Karle, E. M. (2015).
Rewire Your Anxious Brain: How to
Use the Neuroscience of Fear to End Anxiety, Panic, and Worry
. Oakland,
CA: New Harbinger. | anxiety.pdf |
837ebbef820c-0 | References
Baltazar, N. C., Shutts, K., and Kinzler, K. D. (2012). “Children Show
Heightened Memory for Threatening Social Actions.”
Journal of
Experimental Child Psychology
, 112(1): 102–10.
Boswell, J. F., Thompson-Hollands, J., Farchione, T. J., and Barlow, D. H.
(2014). “Intolerance of Uncertainty: A Common Factor in the Treatment of
Emotional Disorders.”
Journal of Clinical Psychology
, 69(6): 630–45.
Craske, M. G., Treanor, M., Conway, C., Zbozinek, T., and Vervliet, B.
(2014). “Maximizing Exposure Therapy: An Inhibitory Learning Approach.”
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, 58: 10–23.
Culpepper, L. (2009). “Generalized Anxiety Disorder and Medical Illness.”
Journal of Clinical Psychiatry
, 70, 20–24.
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Jakubovski, E. and Bloch, M. H. (2016). “Anxiety Disorder-Specific
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M. S., Blum, C. M., and Hood, C. J. (2006). “Progressive Muscle
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and Risk of Incident Coronary Heart Disease: A Meta-Analysis.”
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837ebbef820c-2 | Journal of
American College of Cardiology
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“Paradoxical Effects of Thought Suppression.”
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Social Psychology
, 53(1): 5–13. | anxiety.pdf |
2ab1e948ba1f-0 | Willgoss, T. G. and Yohannes, A. M. (2013). “Anxiety Disorders in Patients
with COPD: A Systematic Review.”
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, 58(5): 858–66. | anxiety.pdf |
38bd3f2ec98c-0 | About
the Author
Jill P. Weber, PhD, is a clinical psychologist in private practice in Washington,
D.C. She is also a psychology author and a speaker. Dr. Weber works with
teenagers, individuals, and couples managing varying degrees of anxiety from
panic attacks, generalized anxiety, and life stress. Dr. Weber uses a combined
approach of cognitive behavioral therapy, mindfulness, and acceptance
techniques when working with anxiety symptoms. She writes a blog for
Psychology Today
and has appeared as a psychology expert in various media
outlets including
USA Today, Washington Post
,
Nightline
,
U.S. News &
World Report,
and CNN. Dr. Weber is the author of
Having Sex, Wanting
Intimacy: Why Women Settle for One-Sided Relationships
and the
Relationship Formula series including the titles
Breaking Up and Divorce 5
Steps, Building Self-Esteem 5 Steps, Toxic Love 5 Steps,
and
Getting Close to
Others 5 Steps
. For more information, see
www.DrJillWeber.com. | anxiety.pdf |
Subsets and Splits