Professional Documents
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Be Calm
Be Calm
Section I: Feelings
Turn to the strategies starting here if you’re feeling strong
emotional or physical symptoms of anxiety.
• Anger/irritability
• Sadness
• Hopelessness/despair
• Insomnia
• Mood swings
• Racing heart
• Shortness of breath
• Dizziness
• Stomach upset
Welcome
Everyone feels anxious at some point! I have worked with
anxious clients for the past 15 years in my practice as a clinical
psychologist. Some come to me believing that their anxious
feelings can improve. Others enter therapy reluctantly, mostly
convinced that nothing will ever reduce their panic symptoms,
avoidance behavior, or worried thoughts. People who improve
typically have two things in common:
1. A part of them, no matter how small, believes they can
get better.
2. They learn, and put to work, effective anxiety-reducing
strategies.
Simply opening this book and reading this far shows that some
part of you believes your anxious symptoms can get better.
And if you’re willing to engage with this material and give
serious thought to the impact anxiety has on your life, there’s a
part of you that wants to get better. Take heart; you already
have all you need to start managing your anxiety symptoms
and living a happier, more fulfilling life.
Getting Started
Keep a notebook or journal handy so you can jot down your
thoughts about the strategies as you try them out. Your notes
will help you reflect on what you’re learning and how your
new skills can help you better cope with anxiety. The more
you practice and write about the strategies, the faster they’ll
become automatic responses to your anxiety triggers.
Once you have your notebook and are ready to start, take a
moment to think about your schedule. Consider how/when you
want to work on this material and when you can best fit it into
your general routine. To really get up to speed with your new
skills, daily practice is the way to go—even if you can set
aside only a few minutes. The point is, give some thought to
how you’re going to integrate this book into your routine.
If you’re in the middle of an acute symptom flare-up, I
encourage you to go directly to the relevant section. So, for
example, if you’re consumed by worried or intrusive thinking,
start with section III, “Thoughts” . If your anxiety is causing
you to avoid important events or people, you may want to start
with section II, “Behavior” . If you’re struggling with your
feelings or physical health, start with section I .
To reach longer-term goals of sustained peace of mind and
inner calm, consider breaking the material down into small,
doable steps so you eventually work through the entire book,
at the pace that suits your life.
CH APTER ONE
Is Anxiety Running Your
Life?
Why We Struggle with Anxiety
A snake on a hiking trail, or a gun in your face, or any direct
threat to your well-being will trigger your fight-or-flight
response. When this happens, the sympathetic nervous system
releases a cascade of hormones, in particular adrenaline and
epinephrine. These stress hormones very rapidly cause a series
of changes in your body, including increased blood pressure
and heart rate, slowed digestion, tunnel vision, shaking, and
increased muscle tension. All this prepares you for a full-
throttle physical response to the danger. These changes come
together in an instant, to create a singular focus on survival .
When anxiety is appropriate—as in the case of the snake or
the gun—this physiological response is normal, because it
prepares us to respond to the potential threat. Even when the
perceived danger isn’t life-threatening, anxiety can still be
helpful. For example, a student might need to achieve a certain
score on a test in order to be accepted to medical school. His
anxiety motivates him to study, take a test prep course, and
spend considerable time on practice exams. The fear of failure
can energize and focus him for the hard work ahead. Or a
person driving on a busy highway suddenly experiences
increased heart rate and blood flow when she sees someone
screech to a halt in the lane next to her. The immediate
increase in heart rate prepares her for action, so she can steer
toward safety if she needs to. These kinds of anxiety responses
may not be saving our lives, but they are adaptive and keep
things running smoothly.
Anxiety becomes a problem when a person’s fight-or-flight
response is triggered by cues that are not threatening at all—
either physically or otherwise. For instance, the person who
obsessively worries about their health even though tests have
ruled out a medical condition. This person is unable to be
present with the people around them because they’re
constantly preoccupied by what might or might not be going
on medically. Or take the person who fears using public
bathrooms and eventually avoids all business travel in order to
not have to confront this fear. If travel is necessary for work,
this person’s career will be limited or ended by what is, at its
core, an irrational fear.
Anxiety isn’t just a problem of overreacting to things
happening around us; our anxiety response can be triggered by
things that exist only in our minds. This happens when we
worry about and anticipate what-ifs and worst-case scenarios,
which may never come to be. Consider the person who feels
insecure and frets relentlessly about the possibility of doing
something wrong socially and being embarrassed. Eventually
their social world becomes smaller and smaller. They may no
longer go to social events and may even stop opening up to
people they’ve known for a long time.
If you’re holding this book, you likely struggle with
anxiety in some way. But you may still have questions about
whether or not anxiety is a problem for you, or about how
serious a problem it is. There are some general ways to assess
if you’re dealing with problematic anxiety, or just the normal
fears that arise in life from time to time.
Anxiety is adaptive when it comes in response to an in-
the-moment fear of risk in your immediate environment.
Anxiety is maladaptive when it becomes a chronic state of
tension, worry, and/or avoidance behavior, all of which
negatively impacts your life and functioning.
The table below describes the differences between normal
fear and problematic anxiety.
FEAR ANXIETY
You’re in the here and now. There is You feel worry and discomfort even
a fire in the house, and you’re though you are not in immediate
figuring out how to put it out. Once danger. No clear threat is present
the fire is out, your fear subsides. and there is no clear way to solve
the concern.
Fear comes from real threats in the For the most part, anxiety isn’t
outside world, e.g., job loss; medical created by the outside world; it’s
diagnosis; illness of a loved one; created by your mind. You worry
threat of being physically harmed; about possibilities that may or may
wanting to do well on a specific not happen, such as: “What if they
task, such as a speech or an exam; don’t like me?” “What if the plane
wanting to make a good impression crashes?” “What if I can’t leave the
on new acquaintances. movie theater?” “What if they hate
me?” “What if I have a panic
attack?” “What if I make a fool of
myself?”
WRAP- UP
• Anxiety is a normal bodily response to threat.
• Feeling fearful about something in your immediate
environment is adaptive.
• Imagining what-if situations that may or may not come to
pass is maladaptive.
• Anxiety responds to treatment; you can and will get better.
• The brain is able to grow and change structurally as the
result of new experiences over time.
• Believing that reducing anxiety is in your control and hard
work will pay off makes all the difference. You can do this!
What You’ll Learn in this Section
Imagine a triangle with “Feelings” in one corner,
“Behavior” in another, and “Thoughts” in the third.
These represent the three main paths to change, which
lead to relief from a wide range of anxiety symptoms.
This book is divided into these three main sections, too.
A change in one corner of the triangle will affect
the other two. If you change your emotions—like
learning strategies to calm your fear and anxiety in
social situations—then you will likely change your
thoughts (“When I calm my anxiety, I can contribute to
the conversation and people will like me”) and your
behavior (you stop avoiding social activities). Simply
put, if you’re trying to effect change, you can start with
any corner of the triangle.
In this first section, we will look at your anxious
feelings, both emotional (sadness, anger, mood swings,
helplessness) and physical (shortness of breath, heart
palpitations, insomnia). You’ll learn better ways of
dealing with your feelings and how to overcome
avoiding or pushing your emotions away. We will also
see how the stress of anxiety can lead to unpleasant
physical side effects, such as digestion problems, racing
heart, and chronic headaches. Together we will uncover
what lurks underneath your anxiety, which may be the
most important factor when life is disrupted by anxiety.
CH APTER TWO
Your Emotions
Are You Suppressing Your Emotions?
A few years back I took a genetic test to determine if I was at heightened risk
for developing certain cancers. I did this at the urging of my doctor, who
rightfully promoted prevention over treatment. This thinking made sound
sense to me, and given that I don’t have a family history of cancer, I believed
I would get the reassurance of longevity. I was shocked when I was told I had
an 80 percent lifetime risk of developing breast cancer. (The average risk is
12 percent.) I distinctly remember thinking, “This can’t be happening; there
must be a mistake in the test.” The information was too overwhelming for me
to process emotionally so I pushed it away. As a result, I became obsessively
focused on negative thoughts about other aspects of my life. I was unable to
sleep most nights, overwhelmed by worries and what-ifs. What I wasn’t doing
was acknowledging my profound sadness and grief. Once I started to get in
touch with the vulnerability I felt, the anxiety became easier to manage.
The more we avoid or push away our emotions, the more anxious we
become. This self-defeating process is a learned habit that actually worsens
anxiety over time, in part because it reinforces anxious thoughts and anxiety-
driven behavior. This happens because to keep the unwanted emotion at bay,
we have to continually work at avoidance. Over time, keeping up this
avoidance becomes something else we’re anxious about. When we, despite
our best efforts, drop our guard even for a moment, the pushed-away
emotions come flooding in and we again anxiously push them away. On this
merry-go-round the original negative emotion goes unaddressed and we
remain ill at ease and hypervigilant.
STRATEGY: CHECK-IN
How Do You Feel Right Now?
As you learn to better identify your feelings you will gain greater emotional
control. This means you will be less prone to intense emotional reactions,
such as panic attacks, emotional meltdowns, blowups, crying spells, and
worried thinking. Plus, knowing what you’re feeling means you can address
the real issue and feel better. When you’re upset or aware you’re experiencing
anxiety, use the following chart to help you label the deeper feeling(s) that
may be underneath your anxiety.
LABELS TO
PHYSICAL/BODILY DESCRIBE ACTION EVOLUTIONARY
EMOTIONS
SENSATIONS YOUR URGES SIGNIFICANCE
EXPERIENCE
Calm body, relaxed Sense of comfort, Desire to be
LOVE Love bonds
muscles, sense of peace safety, comfort with with the
couples, children,
and well-being another, passion, person, to
families, and tribes.
sexual longing bond with
It is the glue that
the other, to
connects people.
make sure
the other is
okay
Go Deeper
Express Yourself
As you explore the feelings table and begin talking about your feelings,
write down in your notebook the emotions that seem to come up for you
the most. Record one or two of these primary emotions. This isn’t a
writing test so don’t worry about your writing style, spelling, or
punctuation. Simply ask yourself the following questions:
• How old were you when you first remember feeling this emotion?
• What was the situation? Was that situation at all similar to what
you’re going through now?
• Did you express what you were feeling to anyone?
• Did anyone comfort you or help you make sense of your feelings?
See if in your writing you can comfort yourself now through self-
compassion and self-acceptance. Tell yourself, “It’s okay to feel this
(your specific emotion).” See if you can let yourself believe that part of
the problem is never having allowed yourself to reflect on and accept
your deeper emotional experiences.
Go Deeper
Understanding What We Learned Early On
Most of us learn how to cope with our feelings while growing up. We
model ourselves based on what our parents did, what they told us about
how to handle negative feelings, or how they interacted with us when we
were upset. These messages can play out over a lifetime and go
unchallenged. For example, Juan, a client I worked with, came to see
that whenever he was upset his parents told him he was fine and not to
worry. Although well meant, this only increased his upset because he had
no outlet to talk through what was bothering him so he could problem
solve the situation and find true relief.
Take some time to think through what may be helpful or unhelpful in
what you learned growing up about managing your emotions. In your
notebook, write about any or all of these prompts that resonate with you.
• Did your caregivers express emotions? Did they cry or get angry? Or
did they seem to have a tight lid on their emotions and rarely
expressed frustration or sadness?
• Do you think you need to appear in control of emotions all of the time
or do you feel completely out of control and so try to clamp down as
much as possible?
• Can you recall any expressions from caregivers, coaches, or teachers
telling you that you are “too sensitive,” “overly needy,” or “too
emotional”?
• Did your family or caregivers describe you as being very
independent/mature as a child? Did you hear a constant “good girl” or
“good boy”? Did you feel as if you couldn’t be a kid with them? Did
you feel there was limited space for you to be you emotionally?
• Consider your memories of joy and happiness in your household as
you grew up. Do you recall your caregivers laughing among
themselves? Did they notice and label your happiness? Or was joy
squelched?
• When upsetting things happened to you as a child, did you feel as if
you could talk to your parents openly? Or did you feel your caregivers
would judge your upset or overly pressure you to “fix it” in some
way? Did you not confide in them at all?
Identify the link between the type of emotional support you were given
in childhood and how accepting you are now of your emotional
experiences. Start changing the way you support yourself emotionally so
you can be more unconditionally accepting of whatever you feel.
WRAP- UP
• All emotions are a normal (and helpful) part of human experience.
• Pushing away negative feelings increases anxious thinking.
• Regularly identifying your feelings will decrease anxiety.
• Expressing your feelings will decrease anxiety.
• Accepting your emotional world will decrease anxiety.
• You can experience negative feelings and still be okay.
CH APTER THREE
Your Body & Physical
Sensations
Anxiety and the Body
Cole struggled with debilitating physical symptoms including
lack of appetite, racing heart, an inability to concentrate,
feeling internally keyed up, and insomnia with racing
thoughts. These distressing symptoms were all he could talk
about because they were so unnerving. Cole understandably
felt as if his body was betraying him and that no amount of
anxiety-reduction work would solve this.
Anxiety regularly shows itself with physical symptoms. At
some point, sometimes after years of experiencing such
symptoms, the dam breaks and the body will no longer be
ignored. For Cole this meant such intense heart palpitations
that he would become dizzy and pass out. Other people might
react in a different way, like succumbing to acute exhaustion,
or no longer being able to drive because of severe back
spasms, or being unable to concentrate because of persistent
headaches. For symptoms like this, anxiety treatment begins
once medical causes are ruled out.
When I see clients like Cole in my psychology practice,
they are usually surprised that “all” they have is anxiety. For
example, for a long time Cole believed that eventually a
specific physical ailment would be identified as the root of his
very real suffering.
Anxiety impacts the brain and the brain impacts anxiety. In
other words, emotions influence our physical functioning and
our physical functioning influences our emotional states.
Improving our overall physical functioning and body
awareness can make all the difference. Cole eventually
became more at ease by learning to observe his physical
sensations and taking better physical care of himself.
Go Deeper
What Else Could You Think About?
Obsessive thinking is a way to avoid facing deeper
emotions. Perhaps we worry we can’t manage the painful
emotions, or perhaps we fear they will overwhelm us.
One client, Jack, told me if he did not think about his
medical condition so regularly, he would begin to feel a
tremendous sense of helplessness and vulnerability. He
felt ineffective and powerless if he was not preoccupied
with his health. Hyperfocusing on his body and medical
care was a way to not feel like a victim; a way to take
charge. With his obsessive thinking, Jack felt like he was
doing something. This was difficult to experience and
express, but once Jack understood his real fear, we could
productively work on helping him feel less vulnerable.
One way we did this was by looking at what he could
control about his medical diagnosis, and then using
acceptance strategies to deal with the rest.
Jack became more self-aware, noticing when his anxiety
was triggered. He did more to quickly identify the
sources of his anxious thoughts. He practiced
mindfulness daily, exercised regularly, ate a healthy diet,
and worked on breathing and positive self-talk. The rest
he turned over to his medical team and the universe.
Take a few minutes to reflect and journal in your
notebook about the following topic:
If you did not fill your conscious mind with thinking
about your medical condition or physical symptoms, the
causes, the worries, the what-ifs, and fears that go along
with it, what would you be thinking about instead?
Explore what you may be avoiding or missing by
engaging in your obsessive thinking. Then, see if you can
talk yourself through those deeper emotions and find a
way to accept them. Remember, acceptance is not
submission; it’s a way to take different steps to protect
yourself than the ones you’ve already taken.
STRATEGY: SLEEP
Sleep is restorative in all respects: mood, cognitive
functioning, energy, and health. Unfortunately, when we’re
anxious we do not reap these benefits because anxiety
typically interferes with sleep. People who struggle with
anxiety wake up to intrusive worries during the night, can’t
fall asleep, or wake up too early.
Creating a nightly sleep routine places cues in the brain.
When practiced regularly, the cues remind us that it’s time to
start unwinding. The key is to follow the routine consistently
so you become accustomed to the cues. Eventually, you will
need only to start your routine to feel more at ease and even
sleepy.
Many expect to go from alert to asleep with no downshift
in between. There’s a middle gear: relaxation. Here’s an
example of a good nightly routine that will help you get into a
relaxed, sleepy state. Work to develop one of your own or use
this one.
One hour before your desired bedtime (ideally the same
time each night), start your routine.
• Unplug from technology. Dock your phone, tablet, or
computer away from your bedroom.
• Take a warm bath or shower.
• Change into sleep clothes.
• Drink a warm decaffeinated beverage, such as chamomile
tea.
• Do a relaxation exercise: meditate through deep breathing,
visualize relaxing imagery, practice progressive muscle
relaxation.
• Lie down comfortably and read fiction or something light.
• Turn off your lights when you feel sleepy and your eyes
start closing.
• When you can’t sleep, don’t think, “Why can’t I sleep?!”
Tell yourself, “It’s okay if I don’t fall asleep, at least I’m
resting.” If waking up continues, try progressive muscle
relaxation with the lights off.
• Don’t worry about the time on the clock. The goal is to
relax even if you can’t sleep.
• Wake up at the same time each morning.
• If you didn’t sleep well the night before, don’t take a nap or
go to bed at an earlier time; stick with the same routine.
IMPORTANT NOTE: Worry often appears at night because we have been
so busy during the day we haven’t been able to emotionally connect with
ourselves so all the things we haven’t thought about crash in once the lights
are out. To counteract this, set aside 30 minutes each day for what I call
“total worry time.” Take out your notebook and put all your worries on the
page: Consider how you’re feeling, what needs to get done, and what worries
you about the days or weeks ahead. Then when the lights are out, your brain
won’t have to remind you of everything you haven’t thought about earlier.
STRATEGY: EXERCISE
Anxious energy needs a release or it will continue to run
amok. Adding regular exercise into your life will pay off.
Thirty minutes of aerobic exercise five days a week will lessen
your stress, increase your self-esteem, improve your sleep, and
improve your physical and emotional functioning. Feeling
good about yourself means you’re more likely to cope well
because you believe in your ability to do so.
Exercise also increases endorphins, the body’s natural
painkiller, and decreases the stress hormone cortisol. It’s worth
it! And if 30 minutes feels like too much too quickly, keep in
mind that research is showing that even a 20-minute vigorous
walk improves cognitive functioning and mood.
Make a realistic exercise goal. Pick something you enjoy doing
so you will continue to do it. For example, walk every day for
15 to 20 minutes. Then after two weeks increase the amount of
time or increase to a light jog. Be sure to check with your
medical doctor that exercise is safe for your physical
condition.
Write down now what your exercise goal is—no goal is too
small; any physical movement is better than none. However,
each time you exercise, your mood will improve and your
anxiety will decrease, so consider doing something on a daily
basis.
When experiencing acute anxiety, employ the “10-minute
remedy.” If you’re anxious and you vigorously exercise for 10
minutes— a brisk walk, jogging, bouncing on a trampoline,
jumping jacks—your anxiety will decrease almost immediately.
Lifting heavy objects or weights for a short time can also
relieve anxiety and tension. Endorphins are released and you
will feel naturally at ease. It will wear off, but the 10-minute
remedy is a quick hit for anxiety.
STRATEGY: NUTRITION
Start looking at food as not only one of the great pleasures in
life but also as a natural means to improving your emotional
functioning. The goal is to eat a varied diet with plenty of
fruits and vegetables. Rid your pantry of all processed foods
and sugar. Adding a variety of nutrients and decreasing sugar
helps the body regulate insulin and hormone levels, which
directly impact mood, anxiety, and energy levels.
A few specific tips about diet and anxiety:
Water: Our body needs water to function, and if it isn’t
functioning properly, mood will suffer. Make sure you’re
drinking 8 to 10 glasses of water daily. When experiencing an
acute bout of anxiety, pour yourself a tall, icy glass of water.
This will quickly change your physiology, turn the brain’s
attention to the cold sensation, and reduce your anxiety.
Caffeine: It’s astounding how many people who struggle with
anxiety also drink a lot of caffeinated beverages. Make no
mistake: Caffeine increases anxiety. Decreasing or eliminating
caffeine and other stimulants from your diet will immediately
lessen the intensity of your anxiety. Consider removing all
caffeine from your diet, and if that’s too hard, halve it and
work down from there.
Nicotine and alcohol: Both nicotine and alcohol have short-
term rewarding effects on the brain but increase anxiety in the
long term. If you drink or smoke regularly, take a break and
see how you feel. For some people this change alone cures
their anxiety overload.
Nutrients: If you have any vitamin deficiencies (check with
your physician), you may benefit from taking specific
supplements, such as vitamin D or a daily multivitamin.
Go Deeper
Goal Setting for Exercise & Sleep (1-
Week Program)
In order to make a long-term impact on your anxiety and
give yourself an emotional boost, consider centering your
goals this week on regular exercise and sleep hygiene.
Think now about how you can fit in 30 minutes of
exercise each day this week. It doesn’t necessarily have to
be at the same time each day but remember: Consistency
makes it easier to stick with a routine. Taking care of
yourself needs to be a higher priority in your life, so you
might have to give something up or put to the side
something that’s important to you.
Then, each day do aerobic exercise for at least 30
minutes. Jog, speed walk, bike, hike, play a vigorous
sport (soccer, basketball, tag with your kids), take an
exercise class. Force yourself to do some kind of activity
every day no matter what else is going on in your life.
Even when you don’t want to do it, remind yourself little
in life pays off as much as an investment in exercise. You
will improve your physical health, your emotional health,
and probably live a longer more fulfilled life—simply by
dedicating 30 minutes each day. Bonus: The release of
endorphins and other rewarding hormones will help you
feel good about yourself.
As we’ve seen, good sleep hygiene is perhaps the most
impactful way to improve mood and anxiety. A regular
nightly wind-down ritual cues the brain to calm and
switch into sleep mode. Make that a goal, starting with a
regular bedtime. Identify which sleep aid techniques
discussed previously you will incorporate into your wind-
down habit. It’s essential to do the routine consistently
and at roughly the same time each night.
After a week, journal about how you feel physically and
emotionally compared to last week. Do you feel any more
positive about your ability to cope? Have you
experienced even slightly less physical tension/anxiety
this week? Could you continue this for another week?
WRAP- UP
• Anxiety impacts the body and the body impacts anxiety.
• Learn to identify and observe (without judgment) where
anxiety manifests in your body.
• Anxiety is associated with a variety of medical conditions.
• Healthy sleep, nutrition, and exercise habits typically
improve anxious symptoms.
• Practicing body awareness exercises helps reduce anxious-
thinking spirals.
CH APTER FOUR
Putting the Tools to Work
Your intention is set. Anxiety will no longer rule your life.
Now you know it’s within your reach to experience a
peaceful emotional life and to feel physically at ease. The
techniques you’re learning in this book can reduce anxiety
on the spot, in the moment that it arises. Repeated use of
the strategies will give you consistent, sustainable
symptom reduction. Here’s how to start taking the
techniques to the next level through building longer-term
habits and goals.
How Do You ✓
Feel Right
Now?
Express
Yourself
Exploring ✓
Anger
Exploring ✓
Sadness
Judging Anger
Judging
Sadness
Let Go of ✓
Judgment
(Meditation)
Practice ✓
Acceptance
Sitting with
Difficult
Emotions
(Meditation)
Body Scan
Progressive
Muscle
Relaxation
What Stories ✓
Are You
Telling?
Take Care of
Medical Health
Practice Good ✓
Sleep Hygiene
Exercise
Nutrition
Mindful
Movement
(Walking
Meditation)
Rate Your 6 7 2 5 3 5 8
Anxiety 1 to 10
Scale
Goal Setting
One way we sabotage our goals is by telling ourselves that we
don’t have the time it takes to make a change. If you’re reading
this book, you spend time worried and anxious, yet you don’t
spend quality time making the changes that will nurture your
mental health. Take a moment now to make a goal to tackle your
anxiety by doing anxiety strategies on a daily/weekly basis.
You may feel vulnerable acknowledging to yourself, and the
people close to you, that you want to improve your anxiety and
that you are going to take deliberate steps to do so. You might
worry that you won’t be successful. It’s sometimes easier,
particularly in the beginning, to say, “I can’t do it,” or “I don’t
need this.” If you hear yourself saying these things, it might be
because you’re afraid of failure. If so, dig deep; believe in your
ability to change. You can and will find relief from anxiety,
provided you learn to believe in yourself.
When it comes to your anxiety, you likely try to deal with it all
on your own. This is hard. Try expressing yourself; tell trusted
friends or family and get their support. Sharing a bit about your
struggle and how you’re working on getting better will make your
goal more real and increase your likelihood of success. And it will
boost your ability to believe in yourself. Joining an anxiety
support group in your community or meeting with a therapist will
also help keep you on task.
Another way people self-sabotage is by asking too much of
themselves too soon. Start with smaller goals and build from
there. Even a little bit of something different creates the
scaffolding for more and more growth. Your belief in your ability
and your motivation to improve will strengthen each time you are
successful and each time you check off implementing a strategy
on your calendar.
Go Deeper
Create Your Weekly “Anti-Anxiety
Calendar”
Purchase a weekly or monthly planner or use your digital
calendar on your tablet or phone. Then look over the current
month. If you have not already done so, write in any work,
social, and family commitments and appointments.
Habit formation comes faster when we teach our brains the
behaviors we’re trying to cultivate on a daily basis. Write in
one strategy from the chapters in this section that you’re
willing to employ every day of the next month.
Now think about when your anxious moments might be
during the coming month. Are there specific days of the week
or times of the day that you anticipate being particularly
anxious? Or are there specific commitments that always
trigger your anxiety?
Get ahead of your anxiety by identifying strategies to use
before you encounter anxiety-provoking situations, and write
down a strategy that you think will be particularly suited for
that specific trigger. For example, if you’re going to have a
pressure-filled meeting at work, you might write on your
calendar “express your feelings through writing” when you
get home that evening. Or if you’re anticipating being
annoyed with a friend or family member, you might practice
“exploring anger” before the visit so you’ll be more aware of
and better able to manage your irritation.
Check- In
It’s all too easy for the brain to slip back into old habitual patterns.
One extremely effective way to prevent backsliding is to make a
regular practice of checking in with yourself and consider the
ways you’re improving/changing.
When you check in, you can assess what’s going well and
what you might have lost sight of on your path to a peaceful life.
And you can 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. Look for other ways to fit in the strategies and be
honest about what is blocking you from making more progress.
Remind yourself that you want this, and you can and will do it.
STICKING WITH IT
Whatever you do, please, please be sure to recognize and celebrate
your successes. I have worked with many people who make major
progress, but once the progress is made they minimize or dismiss
it. When that happens, they self-defeat future progress.
For example, Hannah started therapy not being able to get a
moment’s respite from panic, feeling on edge, and muscle tension.
She was so consumed by her constant worries that she could not
be present, let alone enjoy her life. She made the decision to take
charge and became gradually more at ease emotionally and
physically. Hannah integrated various techniques into her daily
routine and her symptoms improved. She started working again,
enjoying sporting events, and spending time with friends.
Sometimes she would have a reoccurrence of panic and find
herself in a familiar trance where her entire focus was riveted to
worries piling up. It also threw her into a self-critical spiral.
Suddenly thinking she had made no progress at all, she would
abandon the strategies that had brought her relief.
Progress is not a straight line. Setbacks are part of any growth and
change process. Anyone who has raised a child can recall a baby
finally sleeping through the night for a few solid weeks. You think
those sleepless nights are behind you, then, ugh, the baby starts
waking again.
Nevertheless, the typical pattern is for setbacks to become fewer
and fewer over time. Eventually the new behavior becomes
routine.
Every couple of weeks, reflect on where you started. Remind
yourself of what your life was like then and how that anxious life
motivated you to adopt a program to improve. Freedom from
anxiety is here for you. Open up to the ease and calm that is within
your reach. You are worth the investment.
What You’ll Learn in This Section
Imagine again the triangle with “Feelings” written in
one corner, “Behavior” in another, and “Thoughts” in
the third. Any change in one corner of the triangle will
impact the other two. That insight is at the core of all
the strategies in this book. In this section, we are going
to focus on your anxious behaviors and how we can
change them. Anxiety generally results in two main
behavior patterns: avoidance and escape. These two
patterns of behavior allow us to limit, or even totally
eliminate, our contact with whatever makes us feel
anxious. Reducing contact with anxiety triggers makes
us feel better temporarily. But avoidance and escape
patterns come with hidden costs; one of the most
serious costs is that they actually increase anxiety over
time.
This section is designed to help reduce your
anxiety-driven behaviors. Because of the
interconnectedness of those three points on the triangle,
this will, in turn, also help reduce anxious thoughts and
feelings. For example, if you commit to taking the
elevator every day even when your anxiety tells you to
avoid it, you will change your thoughts (“Hey, elevators
aren’t so scary after all”) and your feelings (over time,
you won’t experience as much fear when you take an
elevator).
Responding to anxiety with avoidance/escape
behavior makes your world smaller and smaller.
Eventually you may lose tolerance for even day-to-day,
basic interactions. As we explore strategies to tackle
avoidance/escape behavior, we’ll focus on specific self-
defeating habits, doing what you fear, accepting
anxiety, and increasing your tolerance for uncertainty.
CH APTER FIVE
Avoidance & Escape
The Avoidance Paradox
Imagine standing in front of a beautiful pool on a sunny day.
The pool is full of swimmers making the most of the sunshine.
You’re in your suit and poised on the edge of the water,
looking as if you are ready to dive in and join them. But in
reality, you’re frozen with indecision. Yes, part of you wants to
jump in. You want to make the most of life and enjoy
connection with others. At the same time, a big part of you
dreads the shock of the ice-cold water. You’re stuck. You see
others enjoying the pool, laughing and frolicking freely. You,
however, stand on the side. You feel alone. You feel different.
You pace. You sit down. You start to imagine people are
staring at you, and your anxiety increases. You go back and
forth in your head: “Should I jump in? Or not?” You nurture
your initial impulse to avoid the cold water with more
avoidance. As a result, your fear grows stronger. Finally, you
decide to sit out the pool experience. You feel instant relief,
but feelings of self-consciousness and isolation soon arise.
Your decision to avoid limits your enjoyment, your
spontaneity, and your social life, because your fear has taken
control.
The swimming pool is a simple example, but there are
many ways we avoid what we fear: We avoid by indecision, by
not showing up, by not following through on commitments, by
distracting ourselves with meaningless activities, by making
excuses and rationalizations.
No longer avoiding what you fear means paying attention
to how you feel, not just at the moment you avoid, but over the
longer term. Sure, avoidance brings a temporary reprieve
—“I’m dreading facing my boss today … ah, I’m going to call
in sick … what a relief to not have to deal with that jerk!” The
temporary relief reinforces the tendency to avoid. But the
reprieve is almost always short-lived. New anxiety creeps in
and takes over. What felt like the sweet taste of freedom
becomes bitter with self-critical thoughts about the
consequences your avoidance may bring. What will your boss
think of you for not showing up? What if you get fired? How
will you pay your bills? Are your colleagues criticizing you for
not coming in?
Far from relaxing and enjoying a day off, you’re spinning
back and forth in your mind. Eventually all that anxiety keeps
you stuck in avoidance; you don’t go to work not only that
day, but also the next day and perhaps even the next. Now you
likely have actual negative consequences to face.
Avoidance feels protective in the short term, but in the
longer term generates real peril and more anxiety than ever.
It’s worth keeping in mind that the fundamental problem is not
the anxiety, but how you respond to it.
Hardwired to Avoid
The fight-or-flight response is produced by an area of the brain
often called the “reptilian brain” due to its primitive nature.
The reptilian brain evolved very early and relies on an
unsophisticated operating system; within milliseconds we flee
(avoid/escape) a perceived threat or freeze in place, before we
even process the apparent danger. From an evolutionary
perspective, this instant all-or-nothing response is effective
because, after all, we don’t want to waste precious time on
details when we encounter a real physical threat.
On the other hand, the reptilian response doesn’t work so
well at helping us figure out how to address problems that
provoke anxiety but are not actually threatening . And in
modern life, that describes most of the problems we encounter.
Even a genuinely scary situation—like a performance review
with a boss you don’t like—isn’t an immediate threat to you.
But your reptilian brain doesn’t know this, and may react to
your fear with a fight-or-flight response that’s unhelpful in a
professional setting.
In other words, the fight-or-flight response can be
triggered even when real danger doesn’t lurk. Once the
information regarding the perception of danger makes its way
to our more evolved “upstairs brain,” we’re able to rationally
determine what level of risk the threat truly poses, as well as
problem solve and act strategically. But we have to give that
information a chance to get there, without getting stuck in the
response generated by our reptilian brain.
When Avoidance Becomes the Problem
Ask yourself if you reflexively avoid or overreact to things
that pose no real danger to you. Things that, had you paused
and considered more carefully, you might have realized
weren’t actually such a big deal.
By avoiding the things or situations that trigger you,
you’re essentially deciding that they are too much for you to
manage, when in reality you could deal with them. This
diminishing ability to believe in yourself only increases future
avoidance. Among other misleading thoughts, your anxious
mind probably seriously underestimates your capabilities
(more on this in chapter 8 ). Let’s look at how to start
changing your tendency to avoid.
Right on Target
Behaviors that you want to reduce or change—like
problematic avoidance—are what psychologists call “target
behaviors.” They are the behaviors that we will target with our
interventions. Target behaviors are often unproductive things
you continue to do, even though they’re self-defeating.
For example, Jase feared public speaking and, as a result,
avoided any kind of group meeting at work. In reality, he knew
his job well and wished he could show off his talents through
public speaking. To start, we targeted Jase’s pattern of
skipping meetings. We wanted to reduce, and ultimately
eliminate, that avoidance behavior. He agreed to at least attend
work meetings but not put any initial pressure on himself to
speak. Then he built up to gradually asking a question, and
eventually making longer and longer statements/comments to
the group.
Another client, Alisha, obsessively worried that her
boyfriend would break up with her. To prevent these feelings,
she sought out constant reassurance from him that he would
always be there for her. Like a drug, she needed another and
then another hit of reassurance. She wanted to feel safe and
secure in the relationship. So we targeted her tendency to seek
reassurance. She agreed to reduce requests for reassurance by
25 percent and committed to simply riding out any resulting
anxiety spike. In this way she would not have to go cold
turkey but could begin to adjust bit by bit. It worked. Alisha
started to see that she could manage, and even let go of, her
fears for longer and longer periods of time. And it helped
Alisha’s partner feel less burned out and more compassionate
toward her.
Tackling avoidance requires pinpointing target behaviors.
The table lists a few examples of goals and how to change
your behavior to reach them.
Increase capacity for public Every work meeting, talk for at least three
speaking minutes: ask a question, make a comment, or
clarify something
Go Deeper
What Would Happen If?
This short writing exercise is a way to shift your focus
away from your fear to the positive feelings and strong
sense of self that will come as you rely less on escape and
more on moving forward in spite of your anxiety or
panic.
Write two stories in your notebook:
1. The story of what you expect would happen if you
intentionally exposed yourself to something
you’ve been escaping. Call to mind your worst-
case scenario—all the difficult thoughts, feelings,
or behaviors you imagine would happen if you
stuck with something that instinctively you want to
move away from. Perhaps you believe you would
die, have to leave in an ambulance, lose your
mind, throw up, humiliate yourself … whatever it
is, write it down. Be as specific as possible.
2 . The second story is your best-case scenario of
what could occur if you didn’t use escape to
manage your panic. In this story, you effectively
cope and manage whatever thoughts, feelings, or
behaviors arise. Despite your discomfort you stay.
If you pushed through discomfort, what would be
the result? How would you feel about yourself
then? Imagine feeling good, strong, capable, even
proud.
Uncertainty Intolerance
Remember the Magic 8-Ball from childhood? Ask the ball any
question you wish, shake it up, and poof! A triangle floating in
water delivers an unequivocal answer. If the Magic 8-Ball
really worked, we probably wouldn’t have anxiety disorders;
because it would always tell us what was coming next, we’d
never have to experience uncertainty.
Research shows that people who struggle with chronic
anxiety and worry have great difficulty dealing with
uncertainty—that is, situations with unknown outcomes.
Overthinking—about past events or possible future outcomes
—is a way to bridge the uncertainty gap. When we don’t know
what’s going to happen, our brain gets busy generating a
bunch of hypothetical outcomes to make us feel like we know
more than we do. Take the person going to the doctor for their
yearly blood work. Before the tests, during the appointment,
and up until they receive the results, they imagine and replay
the possible negative results. They even consider various
treatment plans for potential diagnoses and diseases.
The problem with this kind of worry and rumination is that
anxious minds aren’t very rational, and tend to generate
possible worst-case outcomes that aren’t very likely. So, while
worrying about bad outcomes may feel soothing in the short
term, it’s actually making you more and more anxious over
time.
This happens because when we can’t tolerate uncertainty,
we take on more responsibility than is reasonable for a given
situation. A kind of superstitious thinking creeps in, telling us
that the “work” of worry is somehow keeping us safe from the
hypothetical bad things happening. Whether we think about
the blood work results every hour of every day or not, the
results will be what they are. Curiously, when the results come
back indicating all is normal, there is a self-defeating and
irrational tendency to believe that all the worrying made the
difference. And then the next time uncertainty creeps in, we
will be encouraged to worry again to bridge our knowledge
gap.
It’s as if we are saying, “If I don’t worry about this, then
it’s my fault when the bad stuff happens.” Despite the weight
of this pressure, we persevere in our worrying, thinking it will
get us somewhere when in reality it’s only increasing our
anxious state of mind. So we check our email again and again
to ensure we haven’t missed anything. We triple-check that the
stove burners are off, or that the doors are locked every time
we leave the house. We seek reassurance, asking ourselves and
the people around us, “Are you sure you still love me?” “Have
I done everything I can?” “Will my child be safe?” “Do they
think poorly of me?” “Will I ever find a partner?” “Am I
healthy?” “Am I normal?” “Is everything okay??”
Living that way is exhausting, and over time it diminishes
quality of life. The idea that we have to worry or remain
hypervigilant so bad things won’t happen to us is an illusion.
Bad things, including suffering and sorrow, are sadly part of
life. It’s not your job to become certain of the uncertain. The
only real control we have is to accept reasonable uncertainty
so anxiety doesn’t rob us of joy, or of the pleasure of being
fully present in this life now.
STRATEGY: BUILDING
UNCERTAINTY TOLERANCE
Learning to tolerate uncertainty, and seeing that it’s possible to
live with it, is actually much easier in the long run than
overthinking possibilities and imagining terrifying outcomes.
Here are four steps toward increasing your tolerance for
uncertainty:
1. Instead of avoiding uncertainty, seek it out.
2. When uncertainty presents itself, courageously
welcome it with open arms: “I see you, uncertainty, and
I can and I will continue to live fully while you’re by
my side.”
3. Reduce behaviors that reinforce your belief that you
can’t handle uncertainty. If you compulsively check
things, check every few days instead of every day, or
every five hours instead of every hour. If you constantly
seek reassurance, see if you can self-soothe through
positive self-talk, journaling, exercise, deep breathing,
before you ask for another dose of reassurance. If
you’re ruminating about a what-if scenario, internally
label it “can’t be certain of the uncertain.”
4. While strengthening the muscles that will let you
manage uncertainty, pay close attention to the parts of
your life where you do have control. For example,
being present and attentive to children is one way we
can impact their future happiness. Exercising and eating
well helps with health and feeling good. Building
communication skills and positive experiences together
helps a range of relationships stand the test of time. You
may not be able to predict uncertain outcomes, but
those are all things you can do to help ensure things
will go well in the long run!
WRAP- UP
• Avoidance feels relieving in the moment but in the long run
increases anxiety.
• The desire to avoid/escape fearful situations is part of our
brain’s fight-or-flight response.
• The problem is when fight-or-flight is triggered without an
actual threat.
• Challenge your instinct to escape or avoid so new learning
may occur.
• Uncertainty in life is unavoidable; accepting this truth
decreases anxiety.
CH APTER SIX
Acceptance & Approach
Making Peace with Anxiety
Anxiety serves an important function. Worry and concern
enable us to tune in, connect with others, take care of
ourselves, and have empathy. Anxiety also motivates us to set
goals, take action, and pay attention to what matters. I
sometimes see people in my practice who don’t have enough
anxiety. That might sound strange, but they come in feeling
unmotivated, lost, and without purpose. Chances are, if you
live with anxiety, you’re fully invested in your life’s course.
You have the drive needed to achieve an enriching and
meaningful life. The key, however, is to not squander your
precious energy on a struggle against anxiety.
Many of us have a sense that we aren’t living a “good” or
“happy” or “correct” life if we experience even low levels of
distress. If you feel this way, you probably expend a lot of
energy trying to prevent the unpreventable. Joy, love, and
pleasure are magnificent aspects of life. However, in the small
print on life’s contract you’ll find that hardship, loss, suffering,
setbacks, and, yes, anxiety, are also part of the deal.
Instead of trying to rid yourself of things that can’t be
changed, like distress and discomfort, change your
relationship with anxiety by accepting it. Give up the futile
struggle against your feelings and allow your anxiety to come
and go—as feelings always do.
Imagine yourself as a surfer, moving with, not against,
your waves of emotion, and accepting those waves as they
come. You can’t control the waves, but you can take them as
they are, which will help you move through life more
smoothly.
Accepting anxiety doesn’t mean you’re a victim of it or
that you’re giving up and allowing it to control you.
Acceptance doesn’t even mean you like what you’re
experiencing. Acceptance is the idea that it is what it is. When
you look out the window and see rain you don’t say to
yourself, “It’s raining, I have to fix this!” You also don’t say,
“I’m a victim of the rain,” or “I’m being abused by the rain,”
or “It’s raining, I give up.” Perhaps you don’t love the rain, but
you pull out an umbrella, you keep moving forward, and you
know that eventually the rain will stop.
STRATEGY: ACCEPTANCE
Try this experiment to experience the change in perception and
emotional freedom that true acceptance brings.
For this exercise, get your notebook and also find a bandana
or light cloth you can use as a blindfold. I want you to write a
few sentences while wearing a blindfold about your
understanding of the role of acceptance in managing anxiety.
You’re to write as clearly and legibly as possible, making sure
to keep the letters and words lined up, even though you won’t
be able to see what you’re writing. You can do anything you
need to help you with this, except remove the blindfold. Do
your best to try to figure out a way to write as straight as you
can in spite of not being able to see.
Now do the exercise again. This time, don’t worry about
writing straight and on the lines, or making sure your letters
are clear. Just write while wearing the blindfold.
Can you feel the difference? Once you accept the blindfold,
you’re liberated from the anxiety about it.
Go Deeper
Your Best Life
The story you tell yourself about who you are and what
you can and can’t do influences every aspect of your life.
Although you may take your story as fact, it is not. The
accumulation of negative experiences over time can give
us a sense of ourselves that is entirely false. We are so
accustomed to our story that we don’t challenge it or
recognize the ways it blocks our growth. Your story can
be changed.
• Rewrite your story so it can support who you truly
want to be.
• In this process, consider which ideals/values you care
about and want to cultivate.
• Write about what your best life would look like and
also how you would feel on the inside if you were
actually living this life.
• Write specific, doable, action items that will move you
toward living this life starting now, today.
Go Deeper
Exploring Your Struggle
Take some time to sit down and journal about what your
struggle with anxiety is like for you. Here are a few
prompts to focus your writing:
• Write about the ways you have attempted to fight
anxiety. For example, trying to anticipate fear/self-
doubt/worry; making choices in hopes they will keep
anxiety at bay; spending time problem-solving about
things that can’t be solved; trying to make certain the
unavoidable uncertainties found in every life.
• Many people blame themselves. Consider the ways
you may have been too hard on yourself—judgmental
and self-critical—because you feel you “shouldn’t” be
struggling with anxiety.
• Consider how many parts of days, weeks, and years
have been consumed by anxiety. What would it be like
to give up this struggle and accept anxiety? What
would you do with the gift of that free mental space?
• As you write, see if you can connect with a feeling of
compassion for yourself and for what you have
endured in your struggle.
WRAP- UP
• Accepting that anxiety will forever come and go is
liberating.
• Stopping the struggle against anxiety creates room for an
enriching life.
• Identifying your values and larger goals will enhance your
quality of life.
• Making choices and taking action on these larger goals in
spite of your anxiety is empowering.
• Fully accepting anxiety relieves anxiety.
CH APTER SEVEN
Putting the Tools to Work
Implementing anxiety techniques on a routine basis means
you can start to make choices for yourself that reflect your
larger goals and values, in spite of anxiety. You’re no
longer only an anxious person; you are a person who,
along with anxiety, has a rich and meaningful life. Here
are ways to turn the strategies you’re learning into
consistent habits that will enrich your life for the long
term.
Rein in Fight- ✓
or-Flight
Do What You
Fear
Meeting New ✓
People
Building ✓
Uncertainty
Tolerance
Acceptance
Values
Committed ✓
Action
Imagine a
Scenario
Stop Missing
Out!
Watching Your ✓
Thoughts
In Vivo
Exposure
How Did It ✓
Feel?
Inviting
Difficult
Emotions
Take Your
Anxiety Along
for the Ride
Rate Your 7 3 5 2 3 6 7
Anxiety 1 to 10
Scale
Goal Setting
When the rubber meets the road, and you have to actually start
implementing your plan, self-doubt will creep in. Self-doubt is the
enemy of inspiration and change. It’s all too tempting to turn to
excuses: “It’s too hard,” “It will take forever,” “This is going to be
awful.” Allow that to happen and the mental energy required to
improve will be tapped out.
You want to be released from your struggle with anxiety,
which is why you’re reading this page now. However, for many,
the idea of change brings on competing feelings. Yes, there is hope
for something better but also fear that you can’t get there. When
doubt looms, remind yourself that anxiety is highly responsive to
treatment . People who practice these techniques on a regular basis
usually improve. The need for effort doesn’t mean results won’t
come, it just means it will require work.
Take this moment to set a couple of goals for yourself based
on what you read in chapters 5 and 6 . These should be
overarching goals that you can come back to repeatedly for
motivation to stay the course.
Maybe you recognize all you’ve missed out on because of
avoidance behavior, and you want to stop missing out. Or perhaps
you became more clearly aware of what is meaningful and of
value in your life, and you set the goal of making space for those
values, regardless of your anxiety.
Go Deeper
Create Your Weekly Strategies Calendar
Revisit the weekly strategies calendar you created in chapter
4 (here ). Take a moment to look over the current month. If
you have not already done so, write in work, social, and
family appointments and commitments.
People make great progress by simply committing to using
one strategy on a daily basis. This can be a simple/easy
strategy, but doing it daily encourages the habit to become
gradually more automatic. Write in one strategy from
chapters 5 and 6 that you’re willing to commit to using every
day of the month. When you realize you missed a day(s),
which will occasionally happen, just pick up where you left
off.
Assess what’s coming up by digitally or manually marking
red, yellow, and green zones on your calendar. Red zones are
those that are more anxiety fueled, green are those where you
expect to be fairly at ease and feel less internal pressure, and
yellow are in the middle, where you imagine you will feel
neither very anxious nor very relaxed.
Take a step back and look at how much of your month is red
and how much is green. If there’s a predominance of red,
you’re likely carrying too much dread about your activities,
which is no way to live. One of the single best ways to
improve mood is to have things to look forward to. Can you
reduce the red on your calendar and increase the green? Even
a few eliminations can make a noticeable difference.
On days or times where you anticipate anxious triggers, or
see a red zone on your calendar, write down a strategy (or
strategies) that you think will be particularly suited for that
specific trigger. For example, if it’s a dreaded social
encounter, you might put on your calendar to “practice
acceptance,” or “practice being assertive in social situations.”
Or if it’s something you want to avoid but need to approach,
you might practice “imaginal exposure,” where you visualize
yourself doing the thing you want to avoid.
Check- In
One of the reasons weekly psychotherapy is so effective for
treating anxiety is that the regular meeting serves as a cue for the
brain, a reminder of the ultimate goal—a sense of peace and well-
being—and the tools needed to get there. You can do this on your
own, but do commit to checking in with yourself on a regular
basis. Use this time to note your progress and problem solve about
what you could tweak or do differently to be even more
successful. The key is to be flexible and try things differently if
your anxiety is not improving, but don’t give up. It takes
flexibility and patience, but ease and calm await.
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. Remind yourself that you want this, and you can and
will do it.
STICKING WITH IT
It takes practice to integrate new anxiety-reduction routines into
your habitual thinking and day-to-day life. Perseverance requires
that you do not beat yourself up for setbacks. Any time we make a
change or learn something new, we experience disappointments
and obstacles. Use setbacks as learning tools, teaching you what to
do differently next time. Then start again.
No matter what the moment, the day, or the week is like, the key is
to not give up. You can start again at any time. Cultivate patience
and compassion for yourself. You are brave to dedicate yourself to
changing your life. You will be rewarded for your work!
What You’ll Learn in This Section
Once again, call to mind the image of a triangle with
“Feelings” in one corner, “Behavior” in another, and
“Thoughts” in the third. As we’ve seen, working in any
corner of this triangle will change the other two. In this
section, we’re going to relieve your anxious, repetitive
thought patterns. Anxious thinking means you’re
frequently flooded by repetitive and intrusive thoughts.
You wish you could turn your mind off, but the
catastrophic or worried thoughts just keep coming.
Feeling mentally on edge in turn fuels anxious feelings
and avoidance behaviors.
For example, imagine receiving an invitation to a
friend’s birthday party. You might immediately think
something like, “No one is going to talk to me if I go.
I’ll feel awkward.” If you have that thought often
enough, or just believe it enough, you might end up
skipping the party, even though you like your friend
and don’t want to miss out. Or if you do go to the party,
your anxious thinking might nag at you the whole time,
making it an ordeal instead of the fun experience it
should be.
The strategies in this section will help you
challenge the kinds of anxious thoughts that interfere
with your quality of life. The key thing I hope this
chapter teaches you is that you can’t believe everything
you think. We’ll explore why our thoughts often need
to be challenged, and you’ll learn specific strategies
that can be used to do just that.
CH APTER EIGHT
Thoughts vs. Reality
Don’t Believe Everything You Think
You, your resilience, and your capacity for growth are actually
much stronger than your anxious thoughts—although it
probably doesn’t feel like that most of the time. For the
anxious mind, a flood of worry can rise in a matter of minutes,
sweeping you away to a place where what began as a passing
thought becomes in your head an absolute truth. If you watch
your thoughts carefully, you will catch yourself jumping to
extremes and generalizations.
Imagine you get a ticket for a minor fender bender and
then you have the thought, “What if they sue me?” Anxiety
quickly evolves that thought into, “They are going to sue me!”
Or say you get some negative feedback at work and have the
thought, “My boss sees problems with my work.” Anxiety
steps in, and the thought becomes, “I’m going to get fired.” Or
you realize your mom hasn’t returned your phone calls and
you wonder why. Anxiety turns wondering into, “She must
have had an accident.” Or you realize your partner hasn’t
returned a text all day and you worry, “My partner doesn’t care
about me anymore,” quickly followed by, “He’s leaving me!”
This pattern of taking one small, worrisome thought to an
extreme can also be initiated by a physical sensation: “My
heart is beating fast … I must be having a heart attack!” There
are all sorts of frightening, unlikely places your anxious
thoughts will take you—but only if you let them! Believe it or
not, you can intervene and slow this process down.
Imagining catastrophes and worst-case scenarios is
emotionally draining and keeps us from being fully present in
the here and now. But we can learn to sort our thoughts so that
things like over-the-top speculations and black-and-white
thinking are moved to the “discard” pile, at least until you
have solid evidence that those thoughts are realistic. Start
sorting helpful from unhelpful thoughts by taking a little time
(even if only a few moments) to slow down and become aware
of what you’re thinking before you react.
When we slow down, we create space to observe our
thoughts and see if they’re as realistic as they might seem
initially. So the thought, “I’m going to get fired” becomes “I’m
having the thought that I’m going to get fired.” The thought,
“My girlfriend is breaking up with me” becomes “I’m having
the thought that she’s breaking up with me.” Taking a more
curious and observational stance makes room to challenge the
accuracy of your thoughts and weigh their usefulness to you.
I’m helpless.
I’m inadequate.
I’m weak.
Examples of Unlovable Core Beliefs
I’m unworthy.
I’m bad.
I’m unlikable.
I’m unwanted.
I’m not good enough.
The downward arrow technique helps you look beneath the
surface of your anxious thoughts to see what’s really driving
them. To find your core beliefs, record your anxious thoughts,
and then ask yourself, “If that thought were true, what would it
mean about me as a person?”
Let’s use Ava’s anxious thoughts as an example:
“I’m worried I’m not going to complete my report for
work on time. I second-guess my every move. I literally can’t
stop obsessing about work even for a few moments.”
Here is the downward arrow technique:
What does it mean about you as a person if you don’t complete
the report?
“ That I’m letting my team down.”
What does it mean about you if you let your team down?
“My colleagues won’t respect me.”
“That I failed.”
This reflects a helplessness core belief. Deep down, Ava
believes she is inadequate as a person. Likely she is
underestimating her competence (more on this later).
Get your notebook and try the following exercise to get at
your core beliefs.
Identify a situation/interaction/image/thought stream that
brings about anxiety for you.
1. Record the fearful/anxious thoughts you have about, or
when you’re in, the situation/interaction/image/thought
stream (or revisit what you logged for the “Record Your
Thoughts” strategy ).
2. For each thought listed, ask yourself, “If this thought
were true, what does it mean about me as a person?”
3 . Each time you understand what that thought means
about you, write it down.
4. Then ask yourself the same question about new
thoughts listed: “What does it mean about me as a
person if this thought is actually 100 percent accurate?”
Then do the same for the next new thought. Eventually
you will funnel down to a core belief.
Let’s look at another example of the technique in action, this
time with Ahmed. When talking with others, Ahmed appears
calm and collected, but internally he is evaluating his every
word. While on a date or social outing, he believes he appears
awkward. The downward arrow technique follows:
What does it mean about you as a person if your date thinks
you’re awkward?
“I messed up. I lost that opportunity.”
Go Deeper
Identifying Negative Thought
Patterns
Developing awareness of your negative thought patterns
will help you take the steps needed to make you feel
better sooner. When you become aware that you’re
experiencing anxiety, stop and take stock. Write your
answers in your notebook so you can delve into them.
• What is a scenario that is anxiety-inducing for me,
including situations, interactions, events, and images?
Example: Every time my boss is short with me, I withdraw because I
feel anxious and worried that I’m not in good standing at work.
STRATEGY: SPOT
OVERGENERALIZING
As we’ve seen, our worries and catastrophic thoughts often
repeat. We sometimes have new ones, but generally similar
ones repeat over time and reflect the core beliefs we hold
about ourselves. Open your notebook back to the thoughts
recorded earlier in this chapter.
Underline or put a checkmark by the thoughts that reflect a
tendency to overgeneralize. Clues that you might be
overgeneralizing include:
• Taking one example of something upsetting and believing
that example will occur again and again in a variety of
contexts.
• Extreme language: “This always happens,” “It will never be
okay,” “No one will ever like me,” “I’ll never win,” “I am
always the slowest,” “I’m the dumb one.”
• When you hit a setback or receive negative feedback, you
have thoughts about giving up and putting less effort in to
reach your goals.
STRATEGY: STOP
UNDERESTIMATING YOUR
COMPETENCE
Try this visualization exercise:
1. Think through one of your more upsetting thoughts or
worst-case scenarios. In your mind’s eye, play out the
details of what you fear as if it is really happening.
Imagine where you are, whom you are interacting with,
or what news you’re getting.
2. Now imagine your worst-case blocks, setbacks, or
embarrassments, but visualize yourself effectively
coping with what you’re feeling or the other feared
obstacles.
3. Instead of freaking out, giving up, or becoming
painfully uncomfortable with anxiety or fear, you stick
with the situation. You challenge yourself to find a way
to effectively deal with your biggest fear.
4. Imagine you use a strategy (take a few deep breaths,
use internal supportive language, remind yourself of
your larger goals) and it works. You show yourself that
you can cope. You find a way through the
circumstances and emerge in a more comfortable and
thoughtful place.
Practice this exercise and you will be much better equipped to
deal with the real thing.
WRAP- UP
• Become an observer of, not a reactor to, your thoughts.
• Keep a thought record to develop awareness of your
anxious-thought patterns.
• Make anxious thoughts less threatening by identifying
errors in thinking, core beliefs, worry triggers, and
overgeneralizations.
• Increase your awareness for problem-solving versus
unproductive worry.
• When anxious about a future possibility, ask yourself, “Am
I underestimating my competence and/or overgeneralizing?”
CH APTER NINE
Getting Unstuck from
Thoughts
Changing Your Self-Talk
Anxiety increases in intensity when a person’s internal
narrative is filled with harsh judgments around good and bad,
right and wrong. What we say to ourselves influences how we
think about ourselves, what we communicate to others, and
how much we believe in our competence and worth. Anxiety
is further amplified when a person’s internal narrative is
overloaded with generalizations—always, never, forever,
everything, nothing. Consider which of the following two
statements is laden with greater intensity:
1. “I suck, I’ll never get a life.”
2. “I’m lonely and need to work on building social
skills.”
The latter is hopeful. It acknowledges the emotion but also
identifies a specific skill that could be developed to help with
the feeling of loneliness.
If you’re struggling with anxiety, there’s a strong chance
your internal commentary is overly critical and harsh. But
perhaps your anxious thoughts and behaviors about situations
and events have more to do with the critical reaction you
anticipate from others, and less to do with the situations
themselves.
Imagine a friend who, every time you hit a setback, tells
you what you did to cause the problem and reminds you of all
the times in the past you did the same “bad” thing. That is
likely how you’re treating yourself. People who make us feel
good about ourselves and comfortable being ourselves are the
ones we are most at ease with. Start relating to yourself in the
way a warm, kind friend or family member would. Changing
the voice in your head to be more self-supportive and
nurturing will give you a bit of comfort—or padding, if you
will—when negative, anxious thoughts kick in.
Problem- Solving
In psychology, the tendency to work through negative events
by replaying them again and again in one’s mind is called
rumination . Rumination refers to internally focusing on
anxiety/upset, as well as all the reasons, causes, future
possibilities, or risks that could occur due to this distress. An
example might be sitting alone, thinking about feeling behind
your peers academically and employment wise. Then your
mind turns to worrying the situation will never improve and
imagining a future of always feeling inadequate and
professionally lacking. Next, you self-criticize about why this
happened in the first place. And then you may begin to look
for ways to avoid people who might ask questions about what
you do for a living or where you went to college.
Many people worry because they believe they are problem-
solving and engaging in a constructive process about the issues
they face. Reminding yourself of what is or could be of
concern comes to be seen as a way of avoiding denial and
catastrophe.
In fact, rumination is essentially a passive process that
leads only to more anxious thinking. Overthinking, alone in
your mind, leaves no room for other perspectives or effective
problem-solving.
Go Deeper
Brainstorming
Take a more active, direct approach to working through
your worries. Brainstorming is a technique whereby you
take the pressure off yourself by acknowledging that there
is no “correct” decision to make or a “right” way to solve
your issue.
1. Pick an issue that you worry about on a regular
basis or a new worry that has come to mind. Write
down a few sentences about the area of concern.
2. Now write down as many ideas as you can think
of for how you could manage the issue. Pay no
mind to how outlandish or impractical the ideas
might be. There are no rules other than to let the
creative juices flow.
3. The goal here is to open up your process and
escape repetitive thought patterns. In fact, try to
think of ridiculous solutions. This can actually
reduce the seriousness you may feel about the
particular worry. One client I worked with was
struggling with how to deal with a difficult
roommate and came up with the thought, “Every
time she annoys me I’m going to make a joke.” At
first this seemed silly to her, but the idea worked
because it decreased her tension and helped her not
take the roommate so seriously.
4. Once you have a number of various solutions,
think how each possible solution would help or
hinder the problem. Some things will feel
impossible and others will feel as if they barely
help. Pick one that is reasonably doable.
5. Then take an actionable step; actively do
something to relieve your anxiety over this
particular issue.
STRATEGY: UN-LEARN
HELPLESSNESS
Whenever you find yourself anxious or worried, notice if
you’re feeling that life and others are against you. Even if your
blame is warranted, wallowing in it is not going to help you
achieve your goals or make you feel any better. What will help
you feel better is focusing on what is within your control.
Letting go of feeling at the mercy of life or circumstance
creates a feeling of safety and calmness. Here is a way to no
longer face hardship with helplessness:
1. Pick an anxious thought or worry trigger.
2. Recognize the thoughts that keep you in a helpless
state over this particular worry: “I’ll never find a way,”
“It will always be like this.”
3. Come up with three actionable steps you can take and
that are within your control.
4. Take action.
For example, Layla was anxious about an upcoming wedding
she had to attend. She had lost touch with many of the folks
invited to the wedding and felt overwhelmed by worries over
what they would think of her and how she would be socially
on the outside. In order to move away from wallow and worry
toward healthy control, she asked herself what she could do to
improve the situation.
• Reach out to old friends before the wedding. Text, call,
write a note.
Layla connected a bit before the event and even video chatted
with one friend.
• Imagine the day going the way you would like it to.
Layla visualized herself the day of the wedding being present
and in the moment. She imagined awkward encounters, or
even feeling on the outside, but in her visualization, she was
able to cope and manage the situation effectively. She
visualized feeling proud of herself at the end of the event.
• Practice deep breathing, yoga, or mindfulness
meditation.
Layla practiced mindful breathing for 10 minutes a day
leading up to the event.
IMPORTANT NOTE: An actionable item can be accepting a situation as it
is and doing nothing. Then each time the fear comes to mind, practice
acceptance instead of rumination.
STRATEGY: COST-BENEFIT
ANALYSIS (OF YOUR ANXIOUS
MIND-SET)
Sometimes, clearly seeing the consequences for you of a
worried mind-set can motivate you to let go of the worry and
come back to the present moment. With this goal in mind,
conduct a cost-benefit analysis of how beneficial it is to you to
continue to experience anxiety over whatever it is you’re
ruminating or obsessing on. Write out the consequences and
benefits of worrying about a specific issue.
Example:
Costs to keeping anxiety a focus
I’m removed from the present.
I feel bad.
I’m stuck.
Benefit to keeping anxiety a focus
I won’t be surprised if the bad thing I worry about happens.
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 our circumstances. Start seeing yourself
as someone who can (like countless others!) recover from
anxiety.
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.
• Go out in the world, test out your anxious predictions, and
see if they’re accurate.
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.
“Thinking ✓
about” vs.
“Experiencing”
Record Your
Thoughts
Downward ✓
Arrow
Technique
Identify Your ✓
Worry Triggers
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 3 7 9 2 7 5 3
Anxiety on a 1
to 10 Scale
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 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 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 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.
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 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 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.
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 and calm you deserve. Now
keep going. Don’t give up; you’ve already come so far.
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.
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 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 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 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, 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 what is going well, or at least okay, in your
life or what you feel positively about within yourself.
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 every day while driving to work,
with or without stress.
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
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 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 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 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.
The Social Anxiety Institute website also provides a
referral list of 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, 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 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 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 one, chances are others are, too.
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.
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). 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.
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About the Author