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peace for all
Contents
Quick- Start Guide

Chapter One: Is Anxiety Running Your Life?

Section I: Feelings

Chapter Two: Your Emotions

Chapter Three: Your Body & Physical Sensations
Chapter Four: Putting the Tools to Work
Section II: Behavior

Chapter Five: Avoidance & Escape

Chapter Six: Acceptance & Approach
Chapter Seven: Putting the Tools to Work
Section III: Thoughts

Chapter Eight: Thoughts vs. Reality

Chapter Nine: Getting Unstuck from Thoughts
Chapter Ten: Putting the Tools to Work
Section IV: Staying on Track

Chapter Eleven: The Road Ahead

Chapter Twelve: Building Your Support Network
Resources
References
About the Author
 Quick- Start Guide
This book provides a variety of strategies and techniques that
have proven effective at reducing anxiety and its most
troubling symptoms. Any of the strategies you choose to
practice will help your anxiety overall, but I’ve divided them
up here based on which type of symptom they target. This
Quick-Start Guide will navigate you straight to the set of
strategies that will help you deal with acute symptom flare-ups
and anxiety-producing situations.

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

Section II: Behavior

Turn here if your anxiety is making you behave in ways that
you don’t like or that are causing you problems. Section II will
be helpful when your anxiety causes you to:
• Avoid activities you used to enjoy
• Avoid certain people
• Frequently cancel plans
• Call in sick to avoid stressful events like presentations
• Feel unable to do routine things like drive or go to the store
• Behave uncharacteristically in anxiety-provoking situations,
e.g., you don’t approach or talk to your friends when you’re
at a party

Section III: Thoughts

Starting here , you’ll find strategies to help diminish the
inaccurate or unhelpful thinking that preoccupies the mind
when you’re caught up in anxiety. These thought-focused
strategies will help if you’re experiencing:
• Chronic worry
• Repetitive or racing thoughts
• Catastrophic (worst-case scenario) thinking
• Self-defeating thoughts (e.g., “I suck at this, so I might as
well give up.”)
• Irrational beliefs (e.g., “If I don’t drive back home to check
the oven, my house will burn down.”)

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.

How to Use This Book

Psychology is a young science, and there’s still quite a bit we
don’t know. However, we do know how to treat anxiety. Most
people who consistently use the psychological tools in this
book will find relief. My clients who use these methods tell
me that although they are still aware of their worried thoughts,
those thoughts no longer have the same power over them. So
instead of feeling as if the waves in the ocean are pulling them
under and they have to fight for dear life, they realize they can
float—even in a stormy sea. They ride out the tempest by
using their tools and knowing that the waves will eventually
subside and the sea will be calm again.
The strategies in this book are simple to implement. They
are all evidence based, meaning research has proven their
effectiveness. They come from cognitive behavioral therapy
(CBT), acceptance and commitment therapy (ACT,
pronounced like the word act ), and mindfulness practices.
It’s not necessary to go through the book from start to
finish in order to improve. You likely have not experienced the
whole range of possible anxiety symptoms described here, so
you may choose to skip some sections, depending on what
you’re experiencing. Although this is not a workbook, it is full
of practical strategies and instructions for how to implement
them. In each of the nine main chapters you’ll see sections
titled “Go Deeper,” which are suggestions on how to take the
strategies to the next level. (You’ll need a notebook or journal
for these.) The “Go Deeper” strategies are optional, but they
are a great way to maximize your results.
A NOTE TO READERS: The clients in the examples used throughout the
book are composites, and the names are fictional to protect anonymity.

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

Fear is present-focused and Anxiety is future-focused and can

generally rational in that it’s easily become irrational because it is
responding to a threatening situation untethered from real events. Your
or event.
 imagination continually calls up
what-if scenarios.

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?”

What We Can Do About It

The Anxiety and Depression Association of America estimates
that 40 million people suffer from anxiety disorders, which are
the most common issues that bring people to therapy. Thanks
to decades of research, we know a good deal about how to
treat them. In fact, anxiety symptoms of all kinds are very
responsive to treatment, offering anxiety sufferers long-term
relief. This book gives you access to some of the same tools I
use in my practice to help people struggling with all types of
anxiety symptoms.
The techniques in this book are taken mainly from three
scientifically tested and proven-effective interventions. As a
clinician and also as someone who struggles with anxiety, I
have personally found relief using these specific approaches,
and so have my clients. I believe you will, too.
What research and experience have shown me is that a
combined approach of examining your thoughts, accepting
(not necessarily liking!) anxiety as a part of your life, and
learning to be more present in the here and now are the
essential keys to reducing anxiety and living a more peaceful
life.
 Having anxious thoughts becomes a self-perpetuating
cycle that creates more anxiety. We’ll use cognitive behavioral
therapy to examine and change your thoughts. Strategies from
acceptance and commitment therapy will help you behave in a
manner, and ultimately live a life, that matches your core
values and desires, regardless of your mood or anxious
symptoms.
As you grow to accept that we all suffer sometimes, you’ll
find there’s more room for you to separate from your battle
with anxiety. Through practicing the mindfulness strategies
throughout each chapter, you’ll be more easily able to bring
your thoughts back to the here and now. As you learn ways to
observe and distance yourself, even if only slightly, from your
anxious experiences, you will be less overwhelmed and more
able to experience joy and pleasure in your life now.
Habits and Neuroplasticity
Struggling with anxiety can be so demoralizing that we give
up. Similar to traits like height or eye color, people who
struggle with anxiety can start to believe that they were born
anxious and there’s nothing they can do about it. However, the
reality is that changes in our environment, along with learning
new skills, have a significant impact on anxiety and can lessen
anxious symptoms over time.
Neuroscience shows that neuronal growth and structural
changes in the brain occur as the result of new experiences,
and also as the result of how you think and behave. A real-life
example of this would be if you decided you wanted to change
your habit of snacking right before bed. Perhaps you’ve eaten
chips or crackers before bed for years, and you decide to
substitute sliced vegetables. The plan is solid and you’re ready
to go. However, you’re unlikely to be successful in changing
this habit if you substitute your chips for veggies only once a
week or every couple of weeks. On the other hand, if you
consistently eat sliced veggies every night of the week, or even
just most nights of the week, your brain will adjust and the
new habit will take hold.
 When you repeat a new behavior enough (which
continually fires the same neuronal pathway), the new
experience becomes a part of your brain’s system on a
chemical level. This phenomenon is called neuronal plasticity,
or sometimes brain plasticity.
SELF- ASSESSMENT

Tap Your Growth Potential

People just like you, with similar symptoms and levels of
anxiety, have triumphed over anxiety largely because they
believed they could. Recognize if you send yourself self-
defeating messages, such as telling yourself no amount of
work will lessen your symptoms. Just having these thoughts
can hinder your progress.
Take this assessment to see how much you believe in your
ability to grow and have the internal peace you deserve and
desire. If you answer yes often, let’s plan to cultivate your
capacity to believe that freedom from anxiety is possible.
1. When I’m told some way of thinking or behaving will
help my anxiety, I zone out, think nothing can help, or
that this person doesn’t get it.
2. If I have to work hard at something, I feel like
something is wrong with me.
3. I want to stay just as I am, but I am unhappy where I
am.
4. I don’t believe the anxious aspects of my personality
that bother me are changeable through learning and new
experience.
5 . Most of what I do is to survive and get through the day
and less about what I want.
6. I’d rather stay stuck in anxiety than learn new ways of
coping.
As you work your way through the strategies in this book you
will likely start to believe in your ability to grow. Revisit this
assessment from time to time to see the progress you’re
making in believing in yourself. In time, you will look back
and feel both surprised and proud of your growth.

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

Feel-good hormones Delight, joy, Urge to

Pleasure is a tonic
released, increased vivaciousness, smile,
for negative
energy, lack of physical contentment, laugh, talk
emotions and
pain, excited body mastery, feeling lost more with
PLEASURE motivates us to do
in the moment, not others, and
certain things in
thinking about the reveal more
order to experience
future or the past about
more pleasure.
yourself

Tense body, clenched Feeling unfairly Urge to be

Anger cues the
jaw, tightened muscles, treated or aggressive
body to self-protect
increased body disrespected by or harm
through physical
ANGER temperature, feeling of others or the world as another,
force, self-assertion,
pressure behind the eyes a whole, outrage, urge to yell
or boundary setting.
rage, feeling the self or throw
is not valued something

Desire to remain still, Loss, grief, Urge to cry

Sadness is
feeling of lethargy and hopelessness, or sit still in
protective in that it
lack of energy, difficulty rejection, feeling one place,
allows the self to
getting your body to defeated or lack of
mark time while
move unwanted, feeling motivation,
SADNESS grief and problem-
bad about the self urge to
solving can take
dwell on
place.
what you
did to cause
the loss

Stress hormones released Being worried or Urge to be

Anxiety triggers
in the brain, muscle fearful, feeling vigilant,
adrenaline, which
tension, restlessness, threatened by replay
puts the body into
increased heartbeat, something in the events in
high alert, primed
sweating, shortness of environment or one’s mind,
for action and
breath, stomachache within a relationship predict
ANXIETY protection.
(fear of losing a future
relationship), being events,
in high- desire to
alert/vigilant/survival control the
mode threat, flee,
or be busy

Stomachache, aching Feeling like a “bad” Urge to

Guilt keeps people
muscles, feeling that you person, feeling make
in line with societal
can’t be physically at destructive, feeling amends, to
laws and norms
ease you should be be a
GUILT designed for
punished “better”
protecting people.
person, to
berate
oneself

Burning sensation on Embarrassment, Urge to flee

SHAME Shame signifies
face, cheeks flushing, humiliation, the
social status in a
stomach sinking exposure as a fraud, situation, to
group and keeps
fearing a flaw will be become
people in
revealed to another invisible
accordance with
or the public and hide
group expectations.
oneself
 STRATEGY: EXPRESSING YOURSELF
When you’re feeling strong emotions, finding a way to express those feelings
can go a long way toward helping you move through them. There are
countless benefits in talking about our feelings with another person. For
example, I see it over and over again in my practice that a person comes into a
therapy session feeling upset or anxious. They allow themselves to talk about
their feelings for 50 minutes, and they leave feeling significantly better. Many
often say, “That’s too easy. How can merely talking make such a difference?”
The answer is that the act of talking, labeling, and expressing moves
emotional information from your emotional brain to your frontal lobe, which
helps you better understand yourself and feel more in control of your
emotions, which makes you feel better.
Choose a person with whom you can discuss your feelings. Try to look the
person in the eyes while expressing yourself, because maintaining eye contact
with a supportive connection will further soothe your nervous system.
Emotional relief can come by talking with others with whom you have
very little intimacy or contact, such as a therapist or support group. Even
talking online with someone you don’t know that well may help you feel
more accepted and less anxious.

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.

What’s Underneath Anxiety?

When we don’t express negative experiences, they become internalized—we
try to problem solve the upset in an internal vacuum, which results in
overthinking and a sense that we can’t turn our mind off. Without a release
valve, all those negative, doomsday thoughts just keep bouncing around
inside our heads.
Take the example of Zander, a typical patient in my psychotherapy
practice, who is grief struck by the death of a loved one. Instead of expressing
his feelings and allowing himself to be openly sad, he suppresses his pain.
Seemingly out of nowhere Zander finds himself obsessing about the details of
the loved one’s medical expenses, funeral, and the what-ifs now that the loved
one is deceased. Over time, his world becomes smaller and smaller. He is
afraid to go out and spends most of his time at home ruminating (working
through negative events by mentally replaying them again and again).
Another example is Valentina, who after her divorce, blocks the normal
feelings of anger, loss, and sadness and instead becomes obsessively focused
on her weight. She replays in her mind what she did or didn’t eat that day,
plans her next meal, imagines herself larger or smaller. In this way she
occupies her mind to avoid confronting the hurt and upset of the divorce. The
avoidance only increases the loss she has not fully experienced emotionally,
and so she clings more tightly to her unhealthy eating patterns.
If you’re a chronically anxious person, you’re likely in a habit of
suppressing your negative emotions. You may be aware of your anxiety but
unwilling to explore what might be under, or driving, the anxiety. As
uncomfortable as the anxiety feels, it can still feel easier than managing more
threatening emotions, such as anger or sadness or shame or guilt. Let’s take a
look at how to start doing just that.

STRATEGY: EXPLORING ANGER

If you struggle with anxiety, the moment you feel an ember of anger brewing,
you likely blink it away. Anger is adaptive, evolution’s way of motivating us
to protect ourselves through boundary setting and self-assertion.
1. Build awareness of anger. Notice when your body gets tight, your jaw
tenses, or your heart rate increases. Instead of going to your automatic
anxious-spiral default, ask yourself, “What feeling might I be resisting
right now?” and “What might I be missing?” and “Is anger present?”
2. For 10 minutes, without taking any action, without distracting yourself
with your worries, and without self-criticism, tolerate your anger being
present.
3 . Breathe in and out, simply letting yourself be aware of the anger.
NOTE: Becoming aware of anger doesn’t mean you need to react to it. One client I worked with
recognized that when she was starting to become angry her jaw clenched up. Recognizing this
anger signal helped her know when she was angry long before it became intense enough to be
self-defeating.

STRATEGY: EXPLORING SADNESS

Many of us will go lots of other places first, even to rage, rather than willingly
feel the vulnerability of sadness. This short meditation is a safe way to feel an
uncomfortable emotion, by inviting it in rather than feeling overwhelmed by
it. By meeting sadness on your terms, you’ll have the advantage, and you’ll
start to learn that you can actually tolerate feeling sad and that it isn’t such a
threat to you after all.
1. Sit comfortably or lie down on your back. Close your eyes. Allow the
tension in your body to release as you breathe in and out.
2. Invite sadness into your conscious awareness; remember moments
when you felt sadness. Consider when sadness was present but was
overlooked and unattended to. Review your relationships, experiences,
achievements, and various circumstances through the lens of sadness.
3. Now be a gentle, curious observer. Where is the sadness located in
your body? Do you feel tenderness in your stomach, behind your eyes,
a feeling of fragility or vulnerability? Maybe you can observe an urge
to cry or to retreat. Perhaps your heart feels tense or heavy.
4. Recognize when a voice in your head pulls you away. Gently direct
your attention back to your sad feelings.
5. Your suffering only wants to know that you see it and that you no
longer have to hide and suppress it. Repeat internally, “I see you,
sadness. I feel you. I am side by side with you.”
6. Feel the sadness as you breathe in. Release the sadness as you breathe
out. Notice the feeling as it comes in and how observing it allows it to
become less intense.

How Do You Feel About Your Feelings?

We minimize our very real and normal emotions by telling ourselves, “It’s
bad that I feel this way,” or “My negative emotions mean I’m weak,” or
“What’s wrong with me that I feel this way?” or “I’m such a loser because
I’m always upset,” or “No one will ever love me because my emotions are out
of control.” When we negatively judge our emotions, we experience double
the emotional pain. On top of the original hurt or upset, we feel worthless for
having the feeling in the first place.
Telling yourself you’re a weak loser for a feeling you can’t help but
experience is a particularly harsh torment. Take, for example, Tanisha, a client
from my practice. When Tanisha became overwhelmed by sadness or anger as
a child, her parents would immediately dismiss her, coldly telling her to “get
over it” and that she was “too sensitive.” Eventually, whenever she felt hurt,
lonely, overwhelmed, or full of self-doubt, she learned to tell herself the same
things: “What’s wrong with you?” and “Get over it, no one cares!” and “Why
can’t you be cool and keep your feelings together like everyone else?” By the
time she was an adult, Tanisha had layers of unaddressed negative emotions
that came out in the form of crushing panic attacks.
 We can’t eliminate anger and sadness, but we can control how open and
kind we are to ourselves when we experience these feelings. The next
strategies are designed to help you let go of judgment and allow your feelings
to surface.

STRATEGY: JUDGING ANGER

By changing your anger associations, or judgments, you can be at ease with
the emotion. Take a moment to consider what you associate with anger—
whether memories from your childhood and/or adult experiences.
Write down in your notebook four or five specific words you associate with
anger. Do you understand why you associate these words with anger? Where
did the judgments come from? Were they ideas you got from observing others
or things you were told when you experienced anger? Are your associations
with anger mostly negative? If so, why?
Which word holds the strongest association with anger for you? Now, reflect
on its opposite. Can you think of ways this opposite word might be associated
with anger, too?
For example, for many, anger brings up words such as “out of control” and
“destructive.” Opposites of this include “constructive” or “useful.”
Expressing anger is constructive and useful when done in a respectful way
that allows us to set boundaries and take care of ourselves.

STRATEGY: JUDGING SADNESS

Sadness is a feeling that comes about due to grief, rejection, feeling defeated,
unwanted, or unloved. Typically, each of these instances brings on a sense of
loss. The longer the sadness goes unaddressed, the more and more anxious
you become.
Whatever the loss may be, it’s always okay to acknowledge your sadness
about having missed out on something or losing something very dear.
Bring to mind three or four specific occasions when you pushed away the
feeling of loss, grief, failure, or rejection.
• Were you honest with yourself or with others about how sad you really
felt?
• Instead of feeling your sadness, did you go into an anxiety spiral?
• What stopped you from allowing yourself to be purely sad?
• What kind of judgments might you have been making about your sadness?
• Did avoiding the sadness help or hurt you in the long run?
Letting Go of Judgment (short meditation)
It’s important that you practice observing your emotions without having to
immediately push them away. Use this short meditation to gain perspective
and space from your moment-to-moment, ever-changing emotions.
Sit quietly and comfortably. Close your eyes. Bring your breath to your
conscious attention by noticing your chest rising and falling. Meet whatever
emotion or feeling arises in your mind with your inner observer.
Your inner observer carries no judgment. Your inner observer places no
pressure on you to act on your emotions. It merely notes what you are
experiencing.
For example, your inner observer might verbally label: “chest tight,”
“anxious,” “worried,” or “calm,” and “at ease.” If your inner observer
becomes aware of your mind making judgments, simply label it “judging” or
“thinking.” Notice how when you observe and label, the feeling state passes
and then you observe and label the next feeling state.
Nothing you observe is right or wrong. Your emotional experience needs
your calm, accepting awareness, nothing more and nothing less.

Turning Toward Difficult Emotions

Our culture floods us with the message that happiness and success depend on
never experiencing suffering or painful emotions. Of course, we all feel
negative emotions at times, and when we do, we’re left feeling defeated.
Feeling that we must have made a terrible mistake somewhere along the way
(why else would we be feeling so bad?), we spin our wheels doing whatever
we believe necessary to avoid, push away, or somehow “fix” the upset.
We all experience negative emotions, including anxiety. No one is
immune. Even people without full-on anxiety disorders go through anxious
spikes; it’s just part of life. Bringing acceptance to your emotional world
means giving up the fight against suffering and pain, so you may be free in
spite of it. And, too, it means recognizing and believing that experiencing
negative emotions is normal.
Accepting situations and experiences doesn’t mean you want them or that
you’re resigning yourself to a lifetime of emotional pain. Acceptance doesn’t
mean feeling you’re the victim of your pain and that your pain controls you.
Acceptance doesn’t mean you necessarily like what you’re experiencing.
Acceptance is the idea: “It is what it is.”
The metaphor of the Chinese finger trap used in acceptance and
commitment therapy clearly shows how struggling against the experience of
difficult emotions only increases negative emotion. The Chinese finger trap is
a small woven cylinder that children often enjoy. You place a finger in each
end of the cylinder, pull, and—wham—suddenly and unexpectedly your
fingers are trapped. Trying to become unstuck, the inexperienced immediately
attempt to pull their fingers out. The harder they pull, the tighter the tube
becomes, evoking fear and even a little panic. The solution: Push the fingers
toward the center of the tube. The tube becomes slightly bigger and then it is
easy to wiggle the fingers out.
When we continually push away and avoid our experiences, we become
increasingly afraid of the negative. Over time, we stop knowing our feelings
altogether. Even pleasant experiences like joy become blocked. We are no
longer present but instead live in a survival state, waiting for the next shoe to
drop. This crisis-state existence leaves us with an emotional blind spot. After
all, if you’re completely focused on bailing water out of a sinking boat, you
might not notice the life preserver at your side. In my case, spending time
processing and ultimately accepting my genetic cancer risk as a reality led to
the decision to undergo an elective mastectomy with reconstruction—a literal
life preserver that I was unable to see or even consider until I accepted my
situation as it was.
Our emotions provide valuable information and guidance. They tell us
what we want out of life, what we don’t want, how we feel about the people
we are close to, and what we need to work on within ourselves. Acceptance
allows us to play the game of life with the full deck of cards.

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.

STRATEGY: PRACTICING ACCEPTANCE

Although it can be hard to accept painful emotions—to not avoid or push
them away—the consequences that come from not doing so far outweigh the
pain of facing whatever it is you’re really feeling. Come up with several
examples in your life where your lack of acceptance of your feelings has only
caused you more negative emotion or wheel spinning.
As you reflect on these examples, be honest with yourself and acknowledge
the #1 feeling you tend to avoid that brings the most consequences to you—
sadness, anger, anxiety, guilt, shame, frustration, joy.
Consider the results of avoiding this emotion. Has it increased your anxiety?
Caused you to siphon off large amounts of emotional energy in vain? Or has
avoiding this emotion blocked joy and contentment?

STRATEGY: SITTING WITH DIFFICULT

EMOTIONS
It is likely you have avoided negative emotions because you’re afraid of
feeling them or you don’t know how to feel them. Here is a way to do just
that, and it takes only 10 minutes:
1 . Set a timer for 10 minutes. Bring to your conscious awareness an
emotion you tend to avoid or suppress. Try to conjure it up so you can
feel it right now.
2. Observe where in your body you experience the upset or discomfort.
Recognize how it feels. See if you can literally visualize the feeling as
you experience it in your body. Instead of fighting the feeling,
welcome it in.
3. Whisper out loud, “Welcome, I’m glad you’re here.” See if you can
observe the feeling, almost as if you are looking down on a physical
thing separate from yourself.
 4. Internally note: “I notice a feeling of ––— coming over me.” Tell
yourself, “I am making room for you,” or “I can feel this feeling and
also be okay.”
5 . Notice the anxiety that drifts over you as you allow yourself to face a
feeling you always avoid. It’s okay to feel this anxiety. It makes sense
because you’re afraid of this emotion and I’m asking you to feel it. You
can be afraid and still invite the emotion in. Show yourself you can
enter into the feeling and still be okay.
When your time is up, move forward and let go of this experience.

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.

STRATEGY: BODY SCAN

Anxiety inhabits your body. The trick is to start tuning in so
you can more quickly recognize the physical signals. The goal
of this exercise is to develop awareness for where you carry
your anxiety.
1. Pick a position or posture that is most comfortable for
you—lying down or sitting up, eyes open or closed. As
you do this, let go of judgment. You are simply
observing yourself in the here and now.
2 . Each time you breathe out, feel your body relax as it
releases tension. Recognize when your attention shifts
and gently direct it back to your body awareness.
3. One by one, focus on each segment of your body,
opening up to whatever is present in that moment.
Name the body part and imagine you are breathing into
it. Observe areas of tension, strain, pain, or ease: Head
… Neck … Shoulders … Arms … Hands … Chest …
Back … Stomach … Thighs … Calves … Feet …
As you come out of this exercise, make a mental note of where
anxiety tends to rest in your body so you can tune in to that
spot more quickly.

STRATEGY: PROGRESSIVE MUSCLE

RELAXATION
When you notice a spike in anxiety and your body feels tense,
take 5 to 10 minutes for a progressive muscle relaxation. This
strategy also helps when you can’t sleep at night or to
downshift into relaxation before bed.
Lie down or sit comfortably. In turn, tense each muscle in your
body (face, shoulders, hands, arms, stomach, buttocks, legs,
feet) while breathing in for a count of 5, and then release the
muscle while breathing out for a count of 5. While doing so,
pay close attention to the contrast between your experience of
muscle tension and muscle relaxation.
Repeat this exercise a few times. Notice your body loosen and
gradually become more at ease.

Anxiety’s Physical Symptoms

The body’s stress system combined with heredity and
environmental experiences over time can set the stage for a
variety of chronic medical conditions. Persistent exposure to
stress through psychological trauma, grief and loss, life
transitions, habitual worry, and chronic perfectionism can
cripple the adrenal system. The adrenal glands overwork to
manage the ongoing stress, and then eventually give way and
underwork. The result creates a roller coaster of anxiety spikes
followed by exhaustion. Exhaustion can lead to a variety of
medical diagnoses.
Anxiety is also linked with the release of stress hormones
and chemicals that, over time, can worsen medical conditions.
For example, research is showing that stress and chronic pain
are likely linked to the same neuronal pathway. Nerve pain
increases the expression of the neurotransmitter PACAP,
which is the same neurotransmitter the brain releases in
reaction to stress. In other words, stress can bring on and/or
worsen physical pain symptoms.
The body’s biological response to stress can also
significantly impact our cardiovascular, digestive, respiratory,
and endocrine systems. In a large meta-analysis examining
over 20 studies and about 250,000 individuals, researchers
found that anxiety was associated with a 26 percent increased
risk of coronary heart disease and a 48 percent increased risk
of death due to a cardiac-related incident.
The stomach and bowel are directly impacted by the
body’s fight-or-flight response. Over time, nerves that manage
digestion can become reactive, causing unpredictable
abdominal discomfort, such as irritable bowel and upset
stomach. Although the symptoms are not life threatening, they
significantly impact quality of life and can be quite difficult to
manage. In addition, people are more vulnerable to stomach
ulcers when the stress hormone cortisol is released on a
chronic basis.
Anxiety is often present in people with respiratory disease,
particularly asthma and Chronic Obstructive Pulmonary
Disease (COPD). Fear and worry impact breathing, making
these illnesses all the more distressing. The stress reaction due
to anxiety is also linked with migraines, rheumatoid arthritis,
hyperthyroidism, diabetes, and autoimmune illnesses.
Unfortunately, anxiety is often not considered a significant
factor when treating these complicated and often debilitating
symptoms. If anxiety is overlooked, medical symptoms may
become worse. Knowing which of your symptoms are anxiety
related and managing them will improve your overall physical
functioning and psychological well-being.

STRATEGY: WHAT STORIES ARE

YOU TELLING?
There is a back-and-forth interplay between anxiety and
medical illness. The story you tell yourself about your medical
symptom(s) and how it impacts you physically is the variable
we’re going to focus on here. Let’s begin with an example:
My client Sierra endured uncomfortable bouts of
gastroesophageal reflux disease (GERD). The symptoms were
so painful that she was frequently distracted from work and
family responsibilities, slept upright at night and so slept
poorly, and despite medication had a perpetual burning
sensation in her chest. By the time Sierra entered therapy, she
had seen a number of gastroenterologists without gaining
relief. When I talked to her about the relationship between
stress, anxiety, and medical conditions, she was exasperated
and felt that I was minimizing her genuine physical illness.
After some conversation, Sierra softened her view, although
she was unable to believe that her GERD symptoms could be
helped by anything other than a medical fix.
We persevered. She started practicing mindfulness,
changed her diet, and studied the relationship between stress
and physical health. Eventually she became aware that her
GERD, although very real and painful, often flared after she
experienced a stressful event. Armed with this knowledge, she
developed stress-reducing strategies to use each time her
anxiety was triggered. She still experienced GERD but
reported that the intensity of her symptoms halved. As a result,
her symptoms had less of an impact on her life.
Your perception of your ability to manage and control your
medical condition makes a difference. Managing anxiety and
stress better will not take away your medical condition, but it
will enhance your quality of life. Reflect on the following
statements and say them out loud a number of times. The more
you say them, the less you will feel at the mercy of your
physical symptoms.
• I believe I have some control over my physical symptoms.
• I believe if my physical symptoms were to improve it would
be due in part to anxiety-reduction strategies.
• The way I think about my physical state impacts my
symptoms.
• Exercise will likely improve my physical symptoms.
• My current quality of life could improve.
• My medical diagnosis (or physical symptom) is not entirely
out of my hands; I must persevere in living a less-anxious
life.
• Stress-relieving strategies and taking good care of my
physical self will help me feel better physically.
Working to believe these statements will motivate you toward
healthy self-care.

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: TAKING CARE OF YOUR

PHYSICAL HEALTH
It’s important to know exactly what your medical situation is,
otherwise the mind is free to imagine all sorts of alarming
scenarios. And appropriate medical intervention is essential. If
you have not done so already, consider making an appointment
with a medical doctor who considers the whole picture of
physical and emotional health. Tell your doctor about your
physical symptoms and also your struggle with anxiety. Ask
your doctor for a medical physical with blood work as well as
a full thyroid panel test.
Thyroid imbalances impact anxiety and need appropriate
medication. Also, make sure your doctor checks your vitamin
D level. Vitamin D deficiency can impact mood and energy
level. After you talk through the results with your doctor,
make three columns in your notebook:
1. Your specific medical issue(s)
Example: High blood pressure
2. How you’re going to address it medically
Example: Take high blood pressure medication
3. How you’re going to address it in terms of anxiety
intervention
Example: Become aware of anxiety triggers; practice
mindful breathing 15 minutes a day; exercise four days
a week; positive self-talk (“Better managing of my
anxiety will improve my physical health”)

The Mind-Body Connection

I want you to remember the last time you were genuinely
frightened. When it happened, you probably experienced an
increase in your heart rate, change in your breathing pattern, or
became sweaty, shaky, or jittery. These physical symptoms
may have then reinforced your original fearful thoughts. The
mind and the body constantly communicate. If your mind is
filled with a sense of emotional peace, you are much better
equipped to handle medical/physical challenges.
The mind-body connection is empowering because your
anxiety symptoms will likely improve, or even disappear,
simply by taking good, consistent care of yourself. Healthy
sleep, exercise, and nutrition habits usually swiftly improve
anxiety symptoms.

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?

Everyday Body Awareness

When we’re anxious, one worried thought replaces another
and another. This can keep us so stuck that even a few
moments away from anxiety feels impossible, but it is possible
to short-circuit anxious thinking by shifting our attention to
our physical sensations.
Try this: Imagine looking at the sky and focusing intently
on one small black cloud. Now pull back your perspective so
you take in the entire sky, horizon to horizon. From that
perspective, the black cloud loses its significance. In the same
way, switching your attention from your anxious thoughts to
the physical sensations created by those thoughts can alter
your perspective.
When you experience an anxious-thought spiral, observe
your physical sensations—tight chest, tense shoulders, racing
heartbeat, whatever they are—and give them your full
attention, breathing in and out. As you acknowledge it (“I see
you” or “There you are”), it will likely change to a different
sensation. Recognize these sensations are communicating how
alive you are in this moment.

STRATEGY: MINDFUL MOVEMENT

Use the simple act of mindful walking to ground yourself into
the here and now and to let go of or decrease the intensity of
obsessive thinking. You can do this anywhere and at any time
—walking to your car, walking around the grocery store,
walking around your neighborhood, or walking to work.
While walking, focus less on your thinking self and more on
your physical experience. For example, what does your foot
feel like as you lift it and lower it to the ground? How do your
arms feel as you move?
Try to feel the earth from within your body. What is that
sensation like? Does the sole of your foot on the ground feel
heavy? Can you make it soft?
Explore each of your senses. Notice what you feel on your
skin; is the air hot or cool? Do you smell anything as you
inhale and exhale?
Simply observe any sounds you hear. Notice what you see. You
are here in this moment; feel your presence and your alert
state of mind.
With each step, mindfully breathe in, and breathe out. Count
your steps as you inhale and as you exhale. How many steps
does it take as you inhale? How many as you exhale? Keep
your attention on the steps and your breathing.
Each time you become aware of your mind drifting, gently
bring your attention back to observing what it feels like in
your body to walk. There is no rush; all that matters in this
moment is to be aware of your body as it glides through space.

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.

From Strategies to Habits

The great pioneering neuropsychologist Donald Hebb observed,
“neurons that fire together wire together.” Whether it be learning a
new language or responding to an abusive parent, repeated
experiences over time trigger the same patterns of neuronal
activity. At some point, only a tiny cue will trigger that pattern of
activity, and you can expect the same events to occur that have
always occurred in the past. For example, when you see a red
circle in the distance, your brain automatically registers “stop sign
ahead.” You realize as you approach that it’s actually an
advertisement on a red circle, but your initial perception told you
it would be a stop sign, so you had already started downshifting or
easing your foot off the gas. Because old patterns of neuronal
activity fire quickly and before we have time to consciously think,
changing automatic habits can feel hard.
It takes about 90 days to build a new habit. This is roughly
enough time to rewire a bit of your brain. It does take discipline
and effort at the beginning, but with practice, the new coping
strategies become a natural part of your functioning and routine.
Eventually you won’t even have to think about what to do to
reduce your anxiety. You will automatically have a more peaceful
way of being with yourself and coping with the world. This is the
payout! To cultivate the ease and calm you want, stick with the
strategies and put in steady, consistent effort.
Planning
Take a wide-angle look at how your life is organized so you can
begin to think through how and when you will integrate the
techniques into your day-to-day routine.
Outside of your responsibilities—work, school, volunteering,
childcare, social life, family obligations—what do you do for
yourself? When you do have downtime, how do you currently
spend it? People with anxiety often feel as if their downtime is
unpredictable, that they are at the mercy of others, their schedules,
or their anxiety. Stop this pattern by looking at the big picture of
your life. Look for opportunities where you can deliberately
schedule periods of time to work on your anxiety strategies.
Review what you learned in the last two chapters (looking at
your notebook can help) and identify which techniques you want
to start with. How often? What times or days of the week are best?
You don’t have to try every technique; start with two or three that
particularly resonate with you. Try to do your anxiety work at the
same time or times each day. A consistent time gives the brain a
cue that will speed the “neurons that fire together wire together”
process.
Track Your Progress
Tracking progress works for many things, like losing weight or
saving money. And tracking works with anxiety reduction, too. It’s
essential to long-term progress that you set up a system where you
track on a daily basis the strategies you’re using, and the intensity
of your anxiety. Here’s an example of a quick and easy way to
track progress. Each day, check any and all strategies you use
from chapters 2 and 3 . Also be sure to rate your anxiety for the
day, using a 1 to 10 scale, with 1 being entirely relaxed and 10
being full anxiety meltdown. For example, you could create a
table like this:

STRATEGY MON TUES WEDS THURS FRI SAT SUN

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

The 1 to 10 scale is a way to look back and see your progress. At

first you may have quite a few 8s or even 10s, but ideally over the
course of a month you are going to have more days with 5s or
even 4s.

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.

STRATEGY OF THE DAY

Pick a strategy from this section that resonated with you, and work
that strategy into your schedule on a daily basis this week. Helpful
daily strategies include practicing acceptance, letting go of
judgment, and/or mindful breathing. Before you implement the
strategy, visualize yourself doing it. For example, visualize
yourself getting up a little earlier and practicing mindful breathing
for 10 minutes. After visualizing, practice the strategy in real time
each morning.

STRATEGY OF THE WEEK

Pick another strategy that you can work into your calendar at least
three times this week. This does not need to take a long time;
choose one reasonably achievable for you. For example, this
week, commit to brisk walking or light jogging for 20 minutes
three times, or schedule a full medical physical with your doctor,
or complete the “What Stories Are You Telling?” strategy .

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.

STRATEGY: WHAT ARE YOU

AVOIDING?
As we’ve seen, avoidance and escape only beget more
avoidance. The avoidance loop continues because it’s a habit
that becomes unconscious. A helpful step is to consciously
identify what you’re avoiding so you are no longer doing it on
autopilot.
Take a moment to reflect on your patterns of avoidance.
What do you avoid that only causes you problems in the long
run? Here are clues that suggest you’re ducking something that
matters or has meaning to you:
• Saying you will do something but then not following
through.
• Procrastination: delaying a task until tomorrow … then the
next day … and the next.
• Making rationalizations, justifications, and excuses for why
you can’t do something. (“My alarm clock didn’t wake me
up.”)
• Wasting energy/time on trivial thoughts, tasks, and
interactions as a way to distract you from what you should
or need to be doing.
• Frequently telling others, or yourself, that you don’t feel
well physically and that’s why you can’t do something.
Make a list in your notebook of what you avoid. Keep this
focus top of mind, and see if you can catch yourself in the
moment you’re making the decision to avoid. Then try to
make a different choice!

STRATEGY: WHY ARE YOU

AVOIDING IT?
Even dysfunctional, self-defeating behavior continues, or
increases, when it’s rewarded. People keep smoking because
of the rewarding effect of the dopamine hit. Without a serious
desire to make a change, this behavior continues in spite of the
toll smoking takes on health and longevity.
It’s important to identify what is reinforcing, or
strengthening, your tendency to avoid even though you would
like to stop this behavior.
• What do you gain each time you avoid the situations you
listed in your notebook? Some people report feeling a sense
of lightness, like they dodged a bullet, played hooky, or got
out of something truly awful.
• Do you celebrate the reprieve as if you won a prize or
accomplished something? Who’s really winning?
• Consider if avoidance is reinforced because it means you
never have to fully put yourself out there and risk rejection,
disapproval, or failure.
• How else might your avoidance be reinforced?
 Go Deeper
What is Avoidance Gaining You?
Avoidance is a short-term fix that causes more and more
anxiety in the long term. Try this writing exercise to
inspire motivation and focus on longer-term, consistent
relief, versus quick fixes that never last and have negative
consequences.
Write down two lists in your notebook:
1. All the benefits of avoidance. Be very honest with
yourself here; no one else is reading this list. Write
down why you avoid and the positive feelings that
come when you do. Try to emotionally connect
with the feelings—for example, the relief of
pressure or the power of managing to get out of
something.
2. All the benefits of NOT avoiding. How would you
feel about yourself—improved self-esteem, proud,
less shame, strong? What goal might you gain—
greater joy, increased productivity, closer
friendships, increased work competence, increased
spontaneity?
Now compare the two lists. Which list has more in it for
you for the long term? Which list makes you feel better
beyond the moment and also helps you achieve broader
goals for yourself? Set your intention now on what you
want going forward.

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.

GOAL TARGETED BEHAVIOR CHANGE

Increase social Initiate social outings; increase eye contact

connection/closeness with in social situations
people

Increase capacity for public Every work meeting, talk for at least three
speaking minutes: ask a question, make a comment, or
clarify something

Decrease need for Learn to tolerate fears of abandonment:

reassurance from partner positive self-talk, breathing exercises; seek
 reassurance but decrease it by 25 percent
(three times a day instead of four, decrease
from there)

Decrease overthinking Build awareness for rumination by breathing

spiral/rumination and being mindful; talk to people when upset
instead of dealing with the difficulty only in
your head, on your own

Be present and participate in No drug or alcohol use; build awareness of

life when you’re spacing out or daydreaming;
ask questions; be an active listener

STRATEGY: IDENTIFY TARGETS

Based on your goals, identify three or four target behaviors
you would like to change because they get in the way of your
larger goals.
Rate how hard it will be to work on each of these behaviors.
Use a 1 to 10 scale, 1 being not hard at all, and 10 being
nearly impossible.
Rate how motivated you are to work on each of these
behaviors. Use the same scale.
Start with a behavior that’s not going to be too difficult to
eliminate but which is causing enough trouble to motivate you
to work on it. So, using the 1 to 10 scale, consider behaviors in
the 4 to 6 range for difficulty and at or above 5 on the
motivation range. Once you make progress on one target
behavior, momentum will develop, and you can work on other
items as you wish.

The Great Escape

When we avoid, we work behind the scenes to dodge what we
dread. We’re planning ahead to totally eliminate contact with
the trigger. Escape is different; it manifests when we
experience an acute anxiety surge in the moment we contact
the trigger. We then do whatever we have to in order to get
away from it. Imagine what you’d do if you touched an
appliance and got a sudden electric shock—you’d jerk your
hand away immediately. You didn’t manage to avoid the shock
but you did escape it, and minimize your contact with the
unpleasant feeling.
For example, if you have a phobia of crowded spaces, you
may be perfectly fine most of the time living in a bubble that
keeps you in your open-space comfort zone. But terror can
take over if for whatever reason you miscalculate and
suddenly find yourself in a crowded corner at a museum
reception. Your heartbeat jumps. Your face flushes. You shake
and jitter. You may even think you’re going to pass out or have
a heart attack. Similar to a fire alarm sounding, these panic
symptoms cause you to immediately make some excuse and
flee.
As we’ve seen, an adaptive survival response in a true
emergency can, for the person with chronic anxiety, become a
self-defeating pattern of avoiding uncomfortable but
nonthreatening situations. When that happens, a person may
find themselves in total escape mode for situations that are
actually benign—shopping malls, movie theaters, driving,
parties, family events, work meetings, doctor’s appointments,
just to name a few. Giving in to panic and fear through escape
means no new learning can occur because you never get a
chance to discover if what you fear will actually happen.

STRATEGY: REIN IN FIGHT-OR-

FLIGHT
If a lion is attacking, jump off a high wall, run toward
oncoming traffic, crash through a sliding glass door—do
whatever you must to survive. But only rarely do most of us
encounter truly life-threatening situations. In those other
circumstances, the ones that feel scary but pose no real threat,
you’ll get the best outcomes if you rein in your fight-or-flight
response long enough for your “upstairs brain” to kick in, so
you can make an accurate risk assessment. Here are three
quick and easy strategies for decreasing the physical agitation
and arousal—shortness of breath, increased heart rate,
sweating, shaking—that accompany panic and anxiety:
 1. Take slow, deep breaths, feeling your chest rising fully.
Each time you exhale, make the exhalation a little
longer than the one before.
2. If you’re too keyed up to breathe freely, count your
breaths. Counting helps distract your brain from
anxious thoughts. Count 1 when you inhale, 2 when
you exhale, and so forth up to 20. Then start again with
1. Repeat this a few times; the arousal will start to
decrease.
3. If breathing doesn’t work, place your hand on your
heart. Notice the speed. See if you can slow it down
with your breathing. Put all your attention into
observing the beat … beat … beat … of your heart.

STRATEGY: DO WHAT YOU FEAR

(a.k.a. EXPOSURE)
We reinforce escape behavior by never staying in the feared
situation long enough to see if our anxious expectations are
accurate. The only way to test your fears is to put yourself in
the situation(s) that ordinarily make you want to bolt, and see
if your expectations are realistic. Initially this is going to bring
discomfort, but in the long run, it will lead to less anxiety and
less escape behavior.
1. Get out your notebook and write down situations that
typically trigger an urge to escape.
Example: Driving
2. Next to each situation write what you believe would
happen if you stayed in the situation and did not escape.
Example: “If I keep driving when I have heart
palpitations and shortness of breath, I’ll freak out and
crash the car.”
3. Rate how likely you believe each of your listed
expectations is to happen on a 1 to 10 scale (1 being not
at all and 10 being extremely likely).
 4 . Now pick a situation from your list that is moderately
difficult, not painfully difficult, but challenging enough
that you feel the burn. You’re going to intentionally put
yourself into this situation to see that you can cope
better than you imagine.
5. Start with sticking in the situation for a short time and
gradually build up from there. Remember to breathe
(use the “Rein In Fight-or-Flight” strategy ) during this
exercise. You can and will come out on the other side of
this fear.
6. Write down your goal. (We’ll use the previous
example.) Now go and drive the car. Continue driving
for 15 minutes after panic symptoms (rapid heartbeat,
shallow breathing, feeling shaky) are triggered. Use
purposeful breathing to slow down your breathing and
heart rate so the “upstairs brain” can tune in and see that
you’re actually safe.
7. After you have stuck it out, ask yourself the following:
• Did your expectation happen? (“No.”)
• What is the evidence that it happened or didn’t
happen? (“I felt my heart beat fast and I had shortness
of breath but continued to drive for 15 minutes,” or “I
did not crash the car.”)
• What did you learn from this experience? (“I can feel
anxious in my body and still drive safely.”)

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: MEETING NEW PEOPLE

Before entering a social situation, we can never know with 100
percent accuracy what will happen, how we will feel, or what
others may think about us, which is why social situations often
involve a lot of uncertainty anxiety. We can get so caught up in
fears over possible judgments/criticisms/slights that we
become paralyzed at the prospect of hanging out with people.
The more assertive you are, the less likely you are to fear
social interaction. This is because when you exchange eye
contact, speak out, put down boundaries, share your opinions,
people see you and respect you. And, too, speaking up is a
way to clear up misconceptions and miscommunications (both
of which are inevitable in the social world) so the same
distressing social dynamics don’t continue to play out for you
over and over again.
List in your notebook what your fears are before entering a
specific social situation, and next to each fear write out how
you could respond and appropriately handle the situation
should it occur.
• What rejections could occur?
Example: “People won’t talk to me at all,” or “People
will look away and it will feel like I’m not even there.”
Response: “I’ll volunteer to help the host,” or “I’ll
make the plan and initiate the event, so I’ll be an
integral factor.”
• What criticisms could occur?
Example: “If I talk about my job, people will think it’s
boring and that I’m uninteresting.”
Response: “I’ll talk a bit about my job but will
highlight the positive, smile, and maybe even joke
about it,” or “I’ll vary my conversation to include my
job but also my family or a movie I’ve seen.”
• What things matter to you that cannot be predicted in your
social interactions that keeps you avoiding?
Example: “I want to feel like people like me, but I fear
they’ll avoid me or won’t pay any attention to me.”
Response: “I’ll make a point to engage people. I’ll ask
questions, make eye contact, and make them feel I’m
interested in what they say so they’ll enjoy talking to
me.”
If possible, role-play with a friend or therapist where they act
the part of the critical other and you act the part of being
assertive and defending yourself. Or stand in front of a mirror
and literally act out the two sides. Get used to hearing yourself
clarify thoughts or statements without being defensive. A good
formula for this is starting with something validating followed
by a clarifying statement: “I understand what you mean, but
actually I don’t see it quite the same way as you do.”
After practicing assertiveness, get out in the world and talk to
people. You can tolerate the uncertainty of not knowing what
people are thinking and still enjoy the social experiences.

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.

STRATEGY: CLARIFY YOUR

VALUES
Values are the things in life we cherish most, the things that
give our lives meaning. Common examples of core values
include family, spirituality, health, and community. Living a
life that matches your core values increases self-esteem, joy,
and quality of life. The good news is, the strategies you’re
learning here will help you channel your energy away from
anxious patterns and toward the values that matter most to
you, in spite of, or alongside, your anxiety symptoms.
A good way to get in touch with your values is to imagine
yourself on your deathbed. This can be difficult, but imagining
life ending can sometimes connect us with what we want most.
• What do you want others to know and remember about you,
that you did or didn’t do, during your life?
• How do you want to impact the larger world?
• How do you want others you care about to experience you?
Consider writing down what you value in each area of your
life as listed in the next section; remember, a value can be that
you don’t value that particular area.
Relationships (romantic, friendship, family, parent, child):
Professional:
Education:
Religious/ spiritual:
Community:
Hobbies/interests:
Psychological growth:
Physical health:

STRATEGY: COMMITTED ACTION

Identify what you can do now to start living the kind of life
you truly desire. Any small step toward your values will
improve your mood and anxiety. Get out your notebook and
map out a plan to start taking committed action toward
something you value. Here’s how:
1. Identify value:
Example: Psychological growth
2. Identify goal:
Example: Increase self-esteem
 3. Identify step to take to reach goal:
Example short-term action: “Every day do one task
that makes me feel competent—pay the bills, make a
meal, exercise, volunteer, help a friend.”
Example long-term action: “Ask boss about what’s
needed for a promotion,” or “Sign up for a class.”
4. Now take action!

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.

Do the Scary Thing

For many of us, it’s tempting to think the only way to
emotional freedom is to eliminate our anxiety entirely. But as
we’ve seen, total anxiety elimination is self-defeating because
of anxiety’s many benefits and, of course, because it is an
impossible task. Feeling anxious from time to time is
something to accept, not struggle against.
Accepting you’re going to feel anxious at times—
sometimes quite anxious—frees up psychic space that was
occupied by willing anxiety away. This opening is a portal for
achieving goals and living a meaningful life while anxiety is
present .
In fact, when you make room for anxiety to be present
without sounding the fire alarm, you’ll find there’s value in
simply noticing where anxiety crops up. Frequently we
become anxious about things because they matter to us. For
example, when we worry about a social interaction it’s
probably because we really value having a social life. If we
tremble in the face of a job interview, it’s because professional
achievement is important to us. We don’t usually get anxious
about things that are irrelevant to our lives and values.
Instead of turning on yourself when anxiety rears its head,
make room for it and for what it can teach you. Accept
yourself, wholly and completely, the positive and the negative.
Approach what you’re afraid of, because whatever is on the
other side of that fear matters to you. And that’s important,
because you matter.
Paradoxically, fully accepting anxiety relieves anxiety. To
do this, however, you have to legitimately accept it as an
inevitable part of your life. Accepting anxiety just so it will
“go away” won’t work. Tell yourself (and mean it !), “My
anxiety will forever come and go,” and “I can still be okay and
live a valuable life with anxiety.”
Maybe you’ve experienced the freedom that comes with
true acceptance in other parts of your life:
Just when you accepted you wouldn’t find love, you found it.
Just when you accepted your unsatisfactory job situation, it
improved.
Just when you accepted a loss, something was gained.
Just when you accepted your flaws (or the flaws of someone
else), they stopped upsetting you.
Just when you accepted your diagnosis, you became healthier
in other ways.
Acceptance brings less obsessive focus and energy spent on
whatever is troubling us. As we become less singularly
focused, our lens expands to the larger picture. We have the
space to strategize, take risks, and do more to improve our
circumstance.

STRATEGY: IMAGINE A SCENARIO

Use this visualization exercise to get in touch with what you
might gain if you push through your anxiety.
1. Bring something to mind that matters to you but that
you’ve avoided or neglected because of anxiety and
fear. Picture the details. Paint the scene in your mind’s
eye.
2. Try to conjure what you would feel in your body if you
approached what you are afraid of. Notice the physical
cues. Can you feel your heart rate increase or your
stomach sink? Remind yourself that you’re safe; you’re
just pretending.
3. Imagine you follow through with whatever used to
frighten you into inaction, and imagine how you would
feel if you did that. What would you gain?

Anxiety Is Not the Boss of You

Ideally, when our anxiety response is triggered, we make a
swift assessment of how dangerous the situation at hand really
is. Then we’re able to either manage the situation
appropriately (“Get out of the house, there’s a fire!”) or self-
soothe (“You’re okay, take a deep breath.”), return to a calmer
baseline, and move on. When we experience chronic anxiety,
fight-or-flight is triggered so frequently that we are forever on
guard for potential threats, and can never truly relax.
Anxiety can be like a tyrant that controls us to such an
extent that our true nature fades into the background. Over
time it gets harder and harder to recall who we are and what
we want, separate from anxiety, or believe there is another way
to live. Yet it’s possible to break free. You can go your own
way, do your own thing; you can be the boss of the anxiety.
Take the example of Mateo, a high school football player I
worked with in my psychotherapy practice. A gifted athlete,
Mateo was nonetheless consumed by anxiety regarding his
performance on the field. Over time this anxiety stopped him
from going on the practice field at all, which only increased
his anxiety and negative feelings about himself. Not practicing
meant his skills weren’t improving. Mateo worried recruiters
wouldn’t see what he could do and all would be lost.
I suggested to him, “You know you’re really anxious right
now. Your anxiety is telling you to stay home and give up on
your dream of getting a football scholarship. You believe you
have to do what the anxiety tells you. But you don’t have to
listen. You’re in charge, not the anxiety. You could go to
practice while you feel anxious .”
At first, Mateo, like many of us, remained stuck on the
idea that he can’t live with anxiety: “But I don’t want to feel
anxious! I have to figure out the anxiety first.” Then he made
the connection: “Well, I guess I’m going to feel anxious either
way. I didn’t go to practice today and I feel even worse than
yesterday, but at least if I go to practice I haven’t lost anything
else.”
And that’s it. If you make your choices in spite of anxiety ,
you’re retaking control of yourself and your actions—you’re
retaking control of your world. Now you are free. Free to
strive to become a college football player, develop close
friendships, fall in love, travel, be spontaneous, take the final
tests to get the degree, take that medical test that could save
your life, speak up in the meeting so your boss will give you
that promotion, start a new business, plan a party.
Anxiety will not disappear, but it will no longer be your
tyrannical boss—you, your true nature, will be the boss.

STRATEGY: WATCHING YOUR

THOUGHTS
Use this mindfulness exercise to better connect with the part of
you—the observer—that is separate from your anxious
feelings and thoughts.
1. Sit quietly and comfortably. Become an observer of
your thoughts and sensations. You’re not overwhelmed
by your experience and you’re not pushing it away or
judging it. Your experience just is what it is.
2 . Notice that as each thought passes it is replaced by
another … and another … and another. Similar to lying
on your back watching clouds and labeling their
varying shapes and nuances: “fuzzy cloud,” “smoke
cloud,” “bird-shaped cloud.” Watch your thoughts as
they come and go and label them: “worried thoughts,”
“fear thoughts,” “planning thoughts,” “happy thoughts.”
3. Label your observations as they come up using the
sentences below. These sentences are ways to separate
your observing self from your emotions and thoughts:
• “I am aware I am having the thought that ––—.”
Example: I am bad/weak/failure …
• “A feeling of ––— has come over me.”
Example: sadness/dread/hurt/sorrow/joy
• “I am experiencing the thought ––—.”
• “I notice a narrative that tells me ––—.”
• “I am noticing a sense of ––—.”
• “I am noticing a body sensation of ––—.”

STRATEGY: IN VIVO EXPOSURE

In vivo is just a fancy way of saying, “in real life,” and for our
purposes, it means you need to experience the situations
you’re avoiding. Anxiety has dictated a number of your
choices and caused you to miss out. Calling up your fears in
real time, by approaching what you usually avoid, will show
you that you can work through your anxiety in the moment
and get out on the other side. What’s on the other side? A life
full of experiences you value. (When you try your first in vivo
exposures, find a trusted friend to accompany you so you have
support if you start to feel overwhelmed.)
Pick something that you’ve long avoided because of anxiety.
This should be something that will be hard but that you can
imagine pushing yourself to do. Examples might be calling a
friend or relative, going somewhere, speaking up in a group,
asking for something you need, telling someone something
you’ve needed to say for a long time. Take doing the task
slowly. Remember, the anxiety will be there as you push forth
and that’s okay. Here’s how:
1. Take action: Do something you avoid and fear that
blocks you from gaining something important to you.
2. Rein in fight-or-flight: Bring down physiological
arousal by paying attention to your breathing. Make
each exhalation longer than the one before.
3 . Support yourself: Tell yourself, as you push forward
toward your goal and feel that surge of anxiety, “I can
and I will push through. I can and I will push through. I
can and I will push through … ”

STRATEGY: HOW DID IT FEEL?

When we’re anxious, we don’t focus enough on the relief and
even pleasure we experience when we push through the
anxiety and get to the other side. Take a moment now to be
aware of what good came from exposing yourself to the
situation you have previously avoided so you will be sure to
do it again.
• Do you feel any relief in your body?
• Do you feel any pleasure or pride in knowing you did the
thing?
• Did anything good come from doing it?
• Can you imagine doing it again or something similar?
• Which makes you feel better about yourself, approaching
your fears or avoiding/escaping them?
 Giving Up the Struggle
It’s tempting to live life in a constant state of longing. We long
to not experience upsetting or anxious feelings. We long to
win. We long to be better. We long to be free of pain and full
of pleasure. And we berate ourselves when we don’t achieve
what we long for. This mind-set can make life an endless race
to get something, and then something else, and then something
else. Deep down we believe this struggle is one day going to
lead to an end to all of our suffering, an end of wanting more,
and an end to ever feeling bad.
This belief is a fantasy that encourages anxiety to flourish.
Anxiety on some level is never going to end. Believing it can
somehow be controlled or erased becomes a barrier that
prevents people from improving the quality of their lives here
and now.
Take, for example, planning a vacation. You can choose to
approach the planning with anxiety, frustration, or aggravation.
You might worry that you won’t be able to do what you want
to do on the trip, that the flights will be horrendous, and that
all the planning is taking away time from other things you
should be doing. At times you may even tell yourself, “This
trip isn’t worth all this planning, ugh, I give up!” By the time
you take the trip you may be filled with such resentment or
annoyance over the planning and packing that nothing about
the trip will quite make you happy. You return home
dissatisfied and unfulfilled. You vow to take another, better,
more perfect trip in the future.
Alternatively, you can accept the planning process—even
embrace it. You have to do it anyway, so you might as well
enjoy it. You can conjure a feeling of excitement and imagine
your future pleasure as you think through what you want to do.
You can spend time looking at photos, reading articles, and
creating an agenda. When you hit setbacks, you can be flexible
and think of other ways to still get much of what you want out
of the trip.
Dealing with anxiety is similar, in that there’s a choice: On
the one hand, you can forfeit the present moment and succumb
to anxiety, or even self-criticism for feeling anxiety. On the
other hand, you can make room for a larger experience of
yourself other than as just an anxious person. If you want the
latter, when setbacks hit, adjust to the new wave like that agile
surfer, or take a turn in a different direction. Do that and
anxiety’s inevitable presence will not dominate and rob you of
the enriching experiences you deserve.

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.

STRATEGY: INVITING DIFFICULT

EMOTIONS
This strategy is a way to practice giving up the fight against
your emotions. Instead of struggling against them, you’re
actually going to lean in to whatever emotions you might be
experiencing—the pleasant and the unpleasant. Try to actually
invite anxiety (and other unpleasant feelings) to come over
you.
1. Sit comfortably in a quiet location. When anxiety
appears, instead of fighting it (“This is wrong,” “Make
it stop.”), let go of control and give up the struggle.
Welcome anxiety in with open arms: “Yes, I see you,
anxiety, and there’s space for you here with me.” Meet
the surges of unease or worry with warm acceptance.
You can accept your feelings even though they cause
you discomfort.
2. You’re not attempting to change the feeling, push it
away, or keep it present. You’re aware of whatever it is,
as it is . You’re letting go of control in favor of
awareness.
3. As you experience the anxiety, ask yourself, “What
else may be here?” Explore for deeper emotions that
may be hiding under your anxiety. Many anxious
people have not grieved something from their past or
fully acknowledged a hardship they suffered. For
example, perhaps you’re anxious about your partner
possibly leaving you. Dig deeper; what is this worry
connected to from your past? When do you remember
first feeling anxiety over someone leaving? Perhaps you
trace this feeling to your parents’ divorce and your dad
moving out. Now invite in that sadness or anger; see if
you can notice where you feel it in your body. Stick
with the feelings.
4. Work to uncover the root emotion to which each
anxiety branch may be attached. Oftentimes, getting at
the root, where the emotion first presented, can entirely
relieve the anxious feelings. Tell the feelings they’re
welcomed here with you. Validate them as real and
worthy of your attention.
 STRATEGY: TAKE YOUR ANXIETY
ALONG FOR THE RIDE
If you’re like many anxious people, fear and apprehension stop
you in your tracks. You feel as if you have to wait for anxiety
to go away before you can get on with your life. It’s actually
the opposite: for your anxiety to diminish, get on with your life
!
• Take a moment to identify and be aware of your anxiety.
Then task yourself with an activity, errand, or outing. This
doesn’t have to be an all-day event. (You can work up to
that.) Even going to the grocery store or running a few
errands while in an anxious state will do the trick.
• Make sure you follow through completely. In other words,
don’t give up once you’re at the grocery store or after
completing one errand. Remember, you’re apt to feel
anxious wherever you are, so you might as well get some
things accomplished while you’re anxious (and it might just
help you to be less anxious later).
• Once you complete the task, see if your anxiety decreased
at all as a result. Even if it didn’t, congratulate yourself that
you did what you needed to do in spite of the anxiety. Do it
again when you have an opportunity.

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.

From Strategies to Habits

Repeated use of these techniques in a structured, determined
manner will bring you relief far beyond managing your symptoms.
Consider the challenging task of quitting smoking. Smokers say it
usually takes three months for nicotine withdrawal symptoms to
leave the body. Those three months require deliberate effort to
adopt a new learning pattern, but the rewards clearly outweigh the
effort. Three months is nothing compared to a longer, healthier,
and more satisfying life.
Similarly, take the example of Julia. Julia felt extremely
anxious driving on highways with congested lanes and higher
speed limits. Each time she drove on a highway, the same pattern
of neurons fired and a panic attack soon ensued. Julia’s mind
reeled with imagined bad outcomes. Over time, even the thought
of highway driving triggered panic. Eventually she stopped
driving on highways altogether.
In the moment, avoiding what makes us anxious feels like the
fix. In the long run, the avoidance increases anxiety. With
treatment, Julia made a commitment to overcome this anxiety. She
began by visualizing herself driving and coping well. She also
practiced deep breathing to rein in the fight-or-flight response and
supportive self-talk: “I can and I will push through to the other
side.” At first the old anxiety reaction came flooding back in. She
persevered. After two weeks of visualizing, she drove on a
highway again. After two months, she was regularly behind the
wheel and reported that her anxiety had dropped from 10 to 5 on a
scale from 1 to 10.
Julia pushed through. Not only did her symptoms improve but
her quality of life also improved. She was now able to
spontaneously visit her mom and friends. Most importantly, she
felt like the independent and capable woman she always knew
herself to be.
Planning
Reconsider when you will integrate the techniques you planned in
chapter 4 into your daily routine. If you have already begun to do
so, maybe your planning is working. If you have not started to use
the strategies regularly, consider whether you’ve made a realistic
plan. For example, if you commit to practicing the various
strategies for 20 minutes at the end of the day and you aren’t
following through, maybe two 10-minute sessions is a better way
for you to start.
Be flexible and open to new ways of structuring your life, but
do schedule time, ideally a little bit each day, to work on anxiety
reduction.
Track Your Progress
It’s important to long-term progress that you set up a system
whereby you track, ideally on a daily basis, the strategies you’re
using and the intensity of your anxiety.
Below is an example of a quick and easy way to track
progress. Each day, check any and all strategies you use from
chapters 5 and 6 . Also be sure to rate your anxiety for the day,
using a 1 to 10 scale, with 1 being entirely relaxed and 10 being
full anxiety meltdown. For example: The 1 to 10 scale is a way to
look back and see your progress. At first you may have quite a few
8s or even 10s, but ideally over the course of a month, you’re
going to have more days with 5s or even 4s.

STRATEGY MON TUES WEDS THURS FRI SAT SUN

What Are You

Avoiding?

Why Are You

Avoiding It?
 Identify Targets ✓

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.

STRATEGY OF THE DAY

Pick a few strategies from this section that you can incorporate on
a daily basis. For example, an excellent daily strategy that is quite
grounding is “Watching Your Thoughts” . Sit quietly even for five
minutes and observe your thoughts, similar to watching clouds.
Thoughts will arise, and they will pass by—you don’t have to
respond, you only have to observe them. Or sit quietly and
practice acceptance of something troubling you, or invite your
anxiety in and accept those feelings and sensations.
Another helpful strategy is “Take Your Anxiety Along for the
Ride” . In this case, you commit to keeping up with tasks and
commitments, even when you’re in an anxious state. You simply
tell the anxiety, “Alright, I know you’re there; you’re just going to
have to come along with me today!”

STRATEGY OF THE WEEK

Pick a few larger strategies that you can work into your routine at
least three times this week.
 A good place to start and one that will immediately boost your
mood and decrease anxiety is to spend some time each week on
committed action—this could be spending time with a loved one
or volunteering at a local homeless shelter/animal rescue center.
Taking practically any action, no matter how small, that matches
your values will inspire you and also lessen anxiety, even if only
slightly.

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.

STRATEGY: “THINKING ABOUT” VS.

“EXPERIENCING”
This strategy challenges your thoughts in a new way. The
exercise is designed to help you distinguish between your
actual experience and your interpretation of what you’re
experiencing. When we observe, not overthink, we become
liberated from anxiety.
1. Bring all your attention to your heartbeat. Place a hand
on your heart. Or see if you can turn your awareness
inward and actually feel the beating within your chest.
2. Distinguish thoughts from experience. Thoughts might
be, “I can’t find my heartbeat,” or “My heart is beating
too fast,” or “I worry I have a heart condition.” Rather
than judgment or analysis of your heartbeat, experience
your heartbeat, become aware of its rhythm. How does
it feel thumping against the palm of your hand?
3. Like finding the beat in a song, your awareness is less
thought-focused (“Did I get that lyric right?”) and more
experience-focused (“Thump, thump, thump.”).
4 . Sense your chest rising and falling in rhythm with the
sensation of your heart’s beating. See if you can notice
how your heartbeat decreases as you observe it or
increases as you become caught up in your thoughts.
 STRATEGY: RECORD YOUR
THOUGHTS
Keeping a record of your thoughts is a powerful strategy for
breaking out of the anxiety spiral. Instead of those thoughts
going around and around in your head, writing is a way to
examine them in a more realistic, less emotional light. This
kind of reflection puts you in control of your thoughts instead
of your thoughts controlling you. Then you’re no longer
reacting to unrealistic, over-the-top thinking that only ramps
up your anxiety.
Use this exercise when you become aware you’re
experiencing anxiety so you can get better at catching your
thoughts early, before they mushroom. This strategy also helps
when revisiting an anxious moment after the fact.
Identify a situation/interaction/image/thought stream that
brings about anxiety for you.
• What is/was the hardest thing about this situation?
• What is/was your fear in this situation?
• What is/was your imagined worst-case scenario?
• What thoughts were running through your mind during the
event or after or even now as you revisit it?
• Rate how much you believe each of these thoughts. (Use a 1
to 10 scale, with 1 being you don’t believe it at all, and 10
being you believe it completely.)
Come back to this exercise in a day or two, or even a few
hours, and revisit how much you believe these thoughts now.

When Your Thoughts Work Against You

When we’re caught up in anxious thinking, our thoughts feel
entirely real and accurate and so they keep us keyed up. In
truth, the anxious mind isn’t so good at differentiating the real
from the unreal. In this virtual world, we feel as anxious and
frightened as we would if our fear was based on something
really happening. However, in reality, nothing terrible is going
on and there may be little, if any, chance our feared scenarios
will ever happen.
There are a number of biases we’re all prone to that
intensify anxiety. Familiarizing yourself with these “errors in
thinking” will help you catch exaggerated or inaccurate
thought patterns. Here are a few of the more common ones:
All-or-nothing thinking: Things are all good or all bad; you
are perfect or a failure.
Overgeneralizing: If something negative happens in one
situation it means it will happen in all future, similar
situations.
Catastrophizing: You look to the future with sweeping
negativity and forecast disaster instead of more realistic
possibilities.
Labeling: Applying a fixed, global label on yourself or others
without including any context. (“I’m a loser,” “I’m bad,” “I’m
inadequate,” “I’m a burden.”)
“Should”-ing and “must”-ing: You have rigid expectations
for how you should or must act, and when these unreasonable
expectations aren’t met, you forecast horrendous
consequences.
Each time you successfully identify an error in thinking, your
anxiety will decrease because you’re able to see the situation
at hand more realistically, or at least entertain other
possibilities.

STRATEGY: DOWNWARD ARROW

TECHNIQUE
The downward arrow technique is effective for identifying
what deeper belief you hold about yourself that is triggering—
and driving—your anxious thoughts. In cognitive behavioral
therapy, core beliefs are described as your most central
thoughts about yourself and the meaning you ascribe to the
normal difficulties we all face. When a core belief is activated,
your brain switches into a mode in which you take in only
information that supports the belief, and disregard anything
that may challenge it. This traps you in a feedback loop of
biased thoughts generated by that core belief.
When you’re caught up in negative core beliefs, it becomes
difficult to think realistically about the events in your life.
Learning to identify and challenge our core beliefs means
these flawed ideas no longer make decisions for us.
Negative core beliefs typically fall into two general
categories: beliefs associated with helplessness and beliefs
associated with unlovability . See if any of the examples below
sound familiar to you.
Examples of Helpless Core Beliefs
I’m a failure.

Nothing I do will make a difference.

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.”

What does it mean about you if your colleagues don’t respect

you?

“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.”

What does it mean about you if you messed up an opportunity

with that date?
“That people will keep giving up on me.”

What does it mean about you if people keep giving up on you?

“ That I disappoint people.”

What does it mean about you if you disappoint people?

“That no one is going to want me.”

This reflects an unlovability core belief. Deep down, Ahmed
believes no one is going to love him.
 After you use the downward arrow technique with a
number of your anxious thoughts, you will see certain core
beliefs showing up repeatedly. The next step is to start
challenging these deeply rooted ideas you carry about
yourself.

STRATEGY: TEST YOUR CORE

BELIEFS
In this exercise I’m going to push you out of your comfort
zone so you can see if your core beliefs are as accurate as they
feel to you. I want you to literally go out in the world and test
your core beliefs—see if they actually hold up to reality.
If you realize that at the root of your anxious thinking is a deep
fear that you’re unlovable, go out and talk to others, join a
group, make a point to spend time regularly with someone, or
even ask close others if they like you.
If you recognize a core belief that you’re incompetent/helpless,
go out and take on a new but doable task: Sign up for a class,
create something, clean your house, organize a closet, build or
fix something, read a book to completion.
As you enter the situation, insert a different thought (even if
you don’t quite believe it yet!). It could be as simple as “I’m
capable,” or “I can be liked.”
Be open to new information and to what you might be
overlooking that went well or differently from how you
expected. Then modify your beliefs about yourself
accordingly.

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.

• What anxious thoughts am I having (or did I have)

about this scenario?
He doesn’t like me.
He’s going to give me less work and make me unessential.
I’m going to be rendered useless at work.

• How might my thoughts be distorted (label “errors in

thinking”)?
Catastrophizing
Overgeneralizing
All-or-nothing thinking

• What does it mean about me as a person if my most

fearful thoughts are true?
I’ll lose my job.
I’ll be embarrassed.
I won’t meet work goals.
People will know I’m incompetent.

• What core belief was triggered?

Helplessness

• How can I test out my core belief to see if I’m missing

some information?
The next time my boss is short with me, I won’t withdraw but instead
will ask questions about what he’s looking for to see if I’ve missed
anything.

What Are You Worried About?

Worry impacts our emotions in a big way. It influences what
we do and how we feel physically. We can come to exist in an
exhausted, tense-muscled state. This hyperarousal leads to
irritability, difficulty sleeping, and eventually, even depression.
 Here’s a common example I see often in my psychology
practice: A client, Emma, had a repetitive worry that she was
in danger of being kicked out of her graduate program. Each
time something went wrong with an assignment or she
received an average grade, a chain of uncontrollable thoughts
would ensue. She was afraid her professors thought she was
incompetent. She second-guessed herself in class and when
she spoke out was extremely self-conscious. Then she worried
about what the other students thought of her. Emma believed
she wasn’t as intellectually competent as her peers. She would
beat herself up for always worrying: “What’s wrong with me?
I’m so crazy. I can’t stop worrying!”
No matter how hard Emma worked to push them away, the
worried thoughts kept swirling up, again and again. Even
peaceful rest was impossible. She would wake in the middle of
the night harried by her concerns and then be unable to fall
back to sleep. Exhausted from school and worrying, she didn’t
take care of herself, eat right, or exercise regularly. As a result,
she also fretted about her physical health and began to think
she had a serious medical illness.
We all worry on some level, but it becomes
disproportionate when it’s persistent and uncontrollable. When
this happens, we lose time to an internal, not real-to-life focus.
This hyperinternal focus is a vortex where no new energy or
perspectives are allowed in. The vortex distorts reality and
creates greater fear.
Excessive worrying is not problem-solving and is not
productive. In fact, the exhaustion and emotional depletion
actually makes us less productive. We aren’t able to
concentrate, plan accordingly, and make the best use of our
energy and resources. And once again, we’re robbed of the
present moment.
We typically come to recognize we’re in a vortex when the
anxiety is intense. At this point, it can be quite difficult to
escape. The quickest solution is to avoid this stage altogether.
Developing an early warning awareness that reacts before
anxiety has reached high intensity protects us from becoming
stuck in the vortex.
 STRATEGY: IDENTIFY YOUR
WORRY TRIGGERS
Even though we tend to worry about the same things day in
and day out, we persist in wasting time and energy considering
each worry that pops up as if it were new and deeply
significant. Our worries repeat because we fail to problem
solve and cope with them appropriately. Identifying the larger
issues your worried thoughts trigger means you can switch
from worried thinking to problem-solving.
Below is a list of the more common larger issues that
individual worries tend to trigger, and example steps/actions to
take to address each. Identify the categories your worries tend
to fall into and see if you can come up with a few steps to take
for each.
Financial
Actionable step: Develop a budget; meet with financial planner
Job/school
Actionable step: Enroll in a class; get tutor
Achieving goals
Actionable step: Review expectations; are they too high, too low?
Parenting
Actionable step: Read parenting book; take parenting class
Health of self
Actionable step: Get yearly medical physical with blood work
Health of others
Actionable step: Work to accept uncertainty; I can only control so much
Relationships
Actionable step: Read relationship self-help book
Diet/ exercise
Actionable step: Meet with nutritionist; start walking twice a week
Self-image
Actionable step: Build self-esteem through volunteering; go to weekly
psychotherapy
General safety of the world/community (politics, terrorism, environment)
Actionable step: Volunteer for political candidate who espouses my beliefs
If mentally replaying worries made you feel better, you
wouldn’t keep hashing out the same old sets of worries. Shift
your attention from specific worried thoughts to considering
how you could take an actionable step toward improving the
larger issue(s).

STRATEGY: PROBABLE VS.

POSSIBLE OUTCOMES
When we are caught in anxiety quicksand, each and every
worrisome thought may seem acute and reasonable. Stress
hormones are released, anxiety builds, and it becomes difficult
to distinguish the probable from the possible . Instead of
repeating the same concerns over and over in your head, write
out the following for each of your uneasy thoughts:
• What is the worst possible scenario that I’m afraid of
happening regarding this thought?
• What is the best possible scenario that I wish could happen
regarding this thought?
• What is a realistic scenario that will likely happen regarding
this thought?
You can be at peace. Slow down and train your mind to steer
away from far-reaching catastrophe and toward thoughts that
represent the realistic, and most likely, outcomes.

STRATEGY: PRODUCTIVE VS.

UNPRODUCTIVE WORRY
Another helpful strategy when worry thoughts become
triggered is to consider how productive (useful, helpful in your
life or to you) it is to worry about that particular issue. When
you recognize you’re worrying, classify worried thoughts as
productive or unproductive based on the following checklist.
Productive
□ My worry is in regard to a specific problem.
□ My worry is about something I’m going to have to deal
with in the near or immediate future.
□ I have some control over the situation’s outcome.
□ I can make a choice or decision that will solve the worry.
□ This is a new worry, something I don’t usually think
about.
□ There’s an actionable step I can take to help alleviate my
worry.
Unproductive
□ I’m worried about something uncertain in the future that
no one knows whether it will occur.
□ I have no control over this worry.
□ I think about possible ways to deal with the worry, but
nothing feels good enough.
□ I’m obsessively focused and can’t stop thinking about this
worry.
□ This is a recurrent worry of mine.
□ There is no action I can take to solve this worry.
If your worry seems to fall more into the “unproductive”
category, the next time it pops up, remind yourself that it’s
okay to live with some uncertainties. In fact, it’s impossible
not to. Remember to practice acceptance of things as they are.
On the other hand, if your worry is productive, make a plan for
how you want to problem solve the situation at hand. (There’s
more on problem-solving in chapter 9 .)

Overgeneralizing and Underestimating

When we experience normal anxiety, we focus on the
immediate concerns and challenges that no one is immune to,
e.g., “Thanksgiving with the family is going to be hard to get
through this year.” The highly anxious mind compounds these
difficulties by extending them out across time and over a
variety of situations: “Every time I’m with my family, I get
stressed out.” Even worse, the anxious mind convinces us that
we won’t be able to cope with the thing we dread: “I can’t go
to any more family functions, it’s too upsetting.” As a result,
we spin our wheels trying to prevent feared situations,
emotions, and/or interactions by avoiding people and events
that don’t actually pose a real threat. Of course, in reality,
there’s only so much control we have over the course of
events, and so all this anxious energy results in us feeling at
the mercy of life, powerless, and desperate to find relief.
When we overgeneralize, we develop conclusions about
ourselves, our emotions, and what we can and can’t do based
on a single experience. For instance, Carmen found out she
didn’t get her desired work promotion and concludes: “I’ll
never get promoted.” Nolan had a couple of unfulfilling dates
and concludes: “I’ll never meet the right one.”
Overgeneralizing causes you to seal the deal on your fate.
In your mind, you render your future chances of success or
getting what you want at zero. And perhaps most importantly,
overgeneralizing means an end to trying. For example, if you
stop believing you will ever get promoted, you stop putting in
the extra effort at work. If you believe you won’t find a
romantic partner, you stop trying to engage new acquaintances
or actively date.
The second component of the anxious mind is that we
underestimate our ability to cope if what we fear actually
happens. We tell ourselves we can’t possibly manage the
frightening situation our mind is generating: “No way, I
wouldn’t even know what to do,” “I won’t be able to deal with
that,” “That would kill me,” “I’d go crazy.” In the face of a
possible adversity, we imagine ourselves melting into a puddle
of anxious fear. This reinforces the superstitious notion that
worry itself will keep us safe: “If I worry enough, I’ll be
okay,” “If I obsess over this project, I’ll work harder,” “If I
keep myself upset and on edge about this, I’ll be better
prepared when it happens.”
This pattern can be broken. You’re capable of managing
far more than you imagine. Just because you don’t want to
deal with something, or it may be hard to deal with, doesn’t
mean you can’t be effective. You have already managed quite
a bit in your life. You just do it; you push through to the other
side.
 Go Deeper
Challenging Overgeneralization
Perhaps you’re recognizing some of your anxious
thinking represents overgeneralization. Nonetheless, you
still can’t get the fear or thought out of your mind. Start
challenging those overgeneralizations. When you hit a
setback, ask yourself the following questions—and write
your responses down, if you can.
1. Can you think of a time in the past when your
conclusion has not been true?
2. Can you imagine a time or instance in the future
when your conclusion may not be true?
3. How probable, from 0 to 100 percent, do you feel
it is that the fear you’re thinking about is going to
actually happen?
4. What do you gain by believing this thought? For
example, do you believe it keeps you safe in some
way?
5. What consequences may come from believing this
thought? For example, will you give up trying to
get what you desire, allowing a self-fulfilling
prophecy to result?

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.

STRATEGY: BECOME AWARE OF

YOUR SELF-TALK
How we speak to ourselves has a significant impact on
anxiety. Yet we let our anxious self-talk play out again and
again on autopilot. Think about the following questions
regarding your self-talk so you can make the voice in your
head more nurturing and less judgmental.
• What is the tone of your internal dialogue? Is it loud and
impatient, or is it warm and tolerant of what’s going on with
you and your immediate world?
• When you’re upset, does your internal voice try to soothe
you? Or does it use intense/judgmental language that makes
you feel worse, such as, “That was bad,” “You suck,”
“You’re never going to get this right,” “People hate you,”
“You’re a loser.”
• Does your internal voice take away your moments of joy?
When you’re happy or feel at ease, does your voice intrude,
telling you things you need to work on, tasks that need to be
accomplished, or fearful possibilities?
• Are there certain tasks, hobbies, or people that bring out a
kinder, warmer side of you, where your internal voice seems
softer, less critical? If so, these are the things you should do
more of and the types of relationships you should cultivate.
If not, experiment with different activities and people to find
those that bring out your softer side.
Cultivate your capacity for ease and calm, and encourage self-
talk that is compassionate and forgiving. Self-compassion
means showing yourself a warm understanding of your
perceived inadequacies, including your struggle with anxiety.
Forgiveness means voicing a kinder internal monologue when
you encounter a setback or notice your shortcomings.
 STRATEGY: PINK UNICORNS
Write a few sentences about developing compassionate self-
talk while not thinking about pink unicorns. Whatever you do,
stick to the task of writing about developing a compassionate
internal narrative, but make sure NOT to think about pink
unicorns. Pink unicorns should be nowhere in your mind when
you do this task. Each time you think about a pink unicorn,
mark an X in your notebook.
How did it go? Were you able to not think of pink
unicorns? Probably you were not and here’s why: Telling
ourselves to not think about something has entirely the
opposite effect. This is partly why it’s so frustrating when
we’re upset and a well-meaning friend or loved one says,
“Stop thinking about that,” or “Everything is fine, stop
worrying.”
Daniel Wegner, a renowned social psychologist in thought
suppression at Harvard University, asked lab participants to
verbally share their thoughts while being sure to not call to
mind the thought of a white bear. The participants were asked
to ring a bell each time they thought of a white bear. Even
though they were instructed to push away the thought, on
average, they brought to mind the thought of a white bear
more than once per minute.
When we suppress thoughts, we essentially tell ourselves
to “stop thinking about that!” The mind then monitors itself
for each time it does think about “that” and then brings “that”
to our conscious awareness. Instead of criticizing yourself to
stop thinking or worrying about this or that, consider
challenging the thoughts that bring on anxiety.

STRATEGY: REPLACE NEGATIVE

THOUGHTS
When you have a thought that keeps repeating in your internal
narrative, pull out this thought record.
1. What triggered the thought? What were you doing or
imagining when the thought occurred to you?
 Example: Considering an invitation to a neighborhood
potluck.
2. What is the thought(s) that accompanies this trigger?
Example: “No one will talk to me.” “I’ll feel like an
outsider.” “I’ll feel insecure.”
3. Label the emotion(s) you feel when you have these
thoughts and the intensity of each emotion on a scale of
1 (less intensity) to 10 (extreme intensity).
Example: “Inadequate: 5, weak: 6, anxious: 9, dread:
9.”
4. Is there anything that is not supportive of the
thought(s) in #2?
Example: “They invited me to the party, so someone
wants me there.” “I do make small talk with the
neighbors from time to time.” “I live in the same
neighborhood, so we at least have that in common.”
5. Can you think of a replacement thought that might be
less negative but still realistic?
Example: “Even if people aren’t including me in every
conversation, I was invited, and I live in the same
neighborhood so I’m not a total outsider.”
6. Revisit the feelings listed in #3. Rate each one when
keeping this new thought in mind. Recognize if the
feeling(s) decreased in intensity, even if only by a notch
or two.
Example: “Inadequate: 2, weak: 5, anxious: 7, dread:
7.”
Each time the negative thought enters your conscious
awareness, compassionately acknowledge it: “I see you,
negative thinking.” Then bring to mind a more realistic
thought: “Well, at least they invited me.”

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 keyed up and physically ill at ease.

I’m stuck.
Benefit to keeping anxiety a focus
I won’t be surprised if the bad thing I worry about happens.

I will be vigilant, which protects me.

Decide which cost you’re most willing to accept and which
option brings you closer to your long-term goal of having
more peace and less anxiety in your life.
NOTE: It can be quite effective to examine the costs and benefits after
anxiety has lessened. Once the intensity decreases, your brain has the
bandwidth to problem solve and take on a broader perspective.

You Are Not Your Thoughts

While visiting an amusement park with my young son, I
became highly anxious over his enthusiastic desire for me to
accompany him on an old, rickety roller coaster. As he happily
pulled me into the line, worried thoughts gripped me: “It’s
rickety and old, what if it jumps the track?” “What if the
harness breaks when it goes upside down?” “What if the safety
mechanisms fail?” “What if they haven’t kept up with
standards and regulations?” “What if … What if … What if …
” Within a matter of minutes, I fully believed catastrophe
would strike if we rode the roller coaster. I wanted to stop us
both from taking the plunge.
Suddenly, as if waking from a trance, I saw the ride
operator open the door to our roller coaster car and we hopped
aboard. As the machine accelerated, the fearful thoughts began
to retreat into the background of my awareness. There was an
opening now for more than worry.
I became aware of my son’s liveliness and pure elation.
Seeing him throw his hands up in the air, laughing and
smiling. I felt it, too; it was exhilarating to go against my
fearful thoughts. The thoughts were not gone, but I was no
longer a captive of them. I was energized. I was present. I was
in the moment. I was a person who, along with worried
thoughts, was having a thrilling, memorable experience.
Similar to watching an engrossing movie, a particular
thought stream has the potential to pull us in so entirely that
there is no “us” separate from those thoughts. The thoughts
become all-powerful, making choices for us, limiting our
experiences, telling us what’s right and what’s wrong. It’s only
through breaking the trance that we can come to see the nature
of things as they truly are.
Our brains supply us with an inordinate number of
thoughts, many of which are unhelpful and even downright
inaccurate. Taking each one seriously would be like visiting a
beautiful beach and spending the entire time counting the
grains of sand.
Perhaps up until this point, you’ve not even considered
your thoughts as anything other than a literal reflection of your
reality. When a thought enters, you take it seriously. You feel
it, you worry about it, and perhaps even begin to plan based on
it. Accepting thoughts at face value leads to fusing your
identity with whatever you’re thinking in a particular moment.
There should be a space between you, the observer you,
and the thoughts your mind drops on you. You’re not your
thoughts. You’re the leader, the conductor, the captain—the
one who oversees and observes—your thought stream.
STRATEGY: BECOME AN OBSERVER
Observing your thoughts and feelings is similar to standing on
a high rock to watch the sea and reflect on its many changes.
You notice the ocean waves, turbulent at times, peaceful at
others, and often somewhere in the middle. From the safety of
your rock it’s easy to label what you’re observing. You do not
experience yourself as the changes. You are the one noticing
the changes.
Even in a hurricane, the sea eventually becomes calm
again. Observe yourself. Recognize that even though your
brain might be spinning with various anxiety-based scenarios,
it will eventually return to a more peaceful pattern. And a
peaceful brain will inevitably become unsettled again. The
feelings or thoughts that dominate the mind moment by
moment eventually evaporate to be replaced by new feelings
and thoughts. Such is the nature of the mind.
1. Sit quietly. Imagine the observing part of yourself as
separate from your thoughts and emotions.
2. Notice the direction your mind roams and the
accompanying physical sensations in your body.
3. Perhaps you notice tension in your chest, sweaty
palms, or you have a headache.
4. Label these specific sensations without merging your
identity or sense of self with them. For example, “I
notice tension and worry coming over me” as opposed
to “I’m a nervous wreck.”
If you keep practicing, you’ll find that thoughts, emotions, and
sensations pass, only to be replaced by others. Calm invariably
returns. Your thoughts will not frighten you when you
recognize that they are temporary and not a direct reflection of
reality.

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.

STRATEGY: TRAIN STATION

This strategy helps you observe and be aware of your
experience without becoming overwhelmed by it.
1. Imagine yourself safely on an elevated platform in the
middle of a large train station. You have a bird’s-eye
view of each track and see each train as it enters and
leaves your station. You see some trains reenter the
station after just a few minutes. Other trains take longer
to reenter, while others don’t come back at all. Some
trains stick around for a bit before they head back out of
 the station. Other trains leave immediately after
arriving.
2. Imagine your thoughts as these trains. You are the one
safely observing the thoughts come and go. Some
thoughts linger, others leave quickly. You have no
control or urgency or job responsibility around this
other than to be aware of your thoughts as you would
the trains entering and exiting the station.
3. Similar to “red train” or “green train,” see if you can
label each train (thought) as it comes in and out of the
station (your mind). Without judgment or criticism, list
in your notebook, or say aloud, the thoughts that come
through your station. See if you can group the thoughts
into larger categories: “worried thoughts,” “catastrophic
thoughts,” “ family thoughts,” “self-esteem thoughts,”
“future thoughts,” or “work thoughts.” Each time you
label a thought as belonging to a certain category, that
thought becomes less persuasive and less significant.

Test Your Predictions

Do you ever wonder why we tend to put our attention more
into negative thoughts than positive ones? Or why we can still
remember a critical comment or upsetting interaction weeks or
even years after the event? The “negativity bias” is the term
used to describe the fact that undesirable thoughts, emotions,
and interactions have a greater impact on how we feel than do
positive or neutral events. In fact, research shows that people
are much better at remembering negative versus positive
things, including angry versus happy faces, and take more time
and mental energy processing negative events than positive
ones. This bias is part of our evolutionary wiring. From a
survival standpoint, the cost of overlooking a negative is far
greater than the cost of overlooking a positive. Consider the
early man who overlooks a bush loaded with edible berries. He
will probably survive the mistake, but if he fails to look over
his shoulder to see a stalking wolf pack, he may not.
You can see how negativity bias helped our ancestors
survive. But in today’s world, when few of us face real threats
in our daily lives, this bias can result in lots of needless—and
exhausting—worry. When we become overly anxious, the
negativity bias is often the behind-the-scenes culprit. We scan
our environment and ourselves for possible threats and then,
without thoughtful reflection, make improbable forecasts of
bad outcomes.
You can break away from the habitually unhelpful ways
you see yourself and your world by turning each negative
thought into a prediction to be tried out and tested.

STRATEGY: WHAT’S YOUR

ANXIETY TELLING YOU?
When you experience anxious thinking, it likely stops you in
your tracks because you take it as a signal or even a command
for you to worry and ruminate. This may be your negativity
bias operating at full tilt.
What if the anxious thinking is not a signal to stop and
wring your hands but rather a sign that something you really
care about or desire is at stake? When you recognize you’re
making anxious predictions, complete the following
statements to see what might be on the other side of the
anxiety for you and then test out your prediction.
1 . Write down an anxious prediction (or thought).
Example: “If I drive, I’ll have a panic attack. Yet I
haven’t seen my mother in a long time. I worry all the
time about why I can’t drive. I also beat myself up for
being so weak.”
2. Write down why this matters to you.
Example: “I want to visit my elderly mother and spend
time with her. She lives in a nursing home over an hour
away, so I have to drive. I’ve already missed out on so
much time with her, but I can’t deal with the panic.”
3. Write down strategies that might help you.
Example: Practice progressive muscle relaxation, deep
breathing, guided imagery (imagine driving and being
 able to cope and arrive safely). Practice positive self-
talk (“I can and I will drive and see her”).
4. Test out the anxious prediction; see if your hypothesis
was accurate.
Example: “I drove to my mom’s nursing home and I
was uncomfortable but did not lose control and did not
have a panic attack and I got to see my mom!”
Here are specific ways to test common anxious predictions so
you can start working on yours.

WHAT ANXIETY TELLS

HOW TO TEST IT
YOU

I’m afraid the airplane will Practice relaxation exercises, visualization,

crash and I will die. deep breathing and then take a flight.

I’m worried about people Go to a party, work event, neighborhood

not liking me, and being function, and try to interact with people. Ask
rejected. questions; don’t let yourself recede into a
corner.

Take on a new class, work project, hobby.

I’ll never be successful. Build something, take care of a plant, start a
garden.

Ask family if they love you (it still counts

I’ll never be loved. even if it’s family!). Or become a pet owner;
pets provide unconditional love to many.

Notice the little things: light traffic, good

weather, a kind person helping you in some
The world is against me.
way. Catch the world when it’s being good to
you.

Do something that makes you feel

competent: build a garden, take care of an
elderly person or a child, offer to help
I’m useless.
someone in your neighborhood, clean your
place of residence, clean your car, plan an
activity of some sort and follow through.
Now take one of your anxious predictions, remind yourself of
why it matters to you that you work through it, pick a strategy
that will help you, and go out in the world and test it out!

WRAP- UP
• Train the voice in your head toward self-compassion and
self-acceptance.
• Replace anxious and negative thoughts with realistic
thoughts.
• Make goals and take actionable steps to lessen anxious
rumination.
• 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.

From Strategies to Habits

If you continue to cultivate your skills for finding ease and calm
when anxiety is triggered, eventually your anxiety patterns will
begin to break, and in the spaces that open up you can cultivate
new habits of thinking and responding. It’s important to remember
that changing the brain’s wiring takes time and consistent practice.
It’s just when we think we can’t take it anymore and want to give
up that we make our biggest gains. Eventually, for longer and
longer periods of time, you’ll forget that you’re practicing healthy
coping. Instead, you’ll enjoy the breeze on your face and the
experience of living in this life now.
Consider what can come if you continue to do this work.
Perhaps your baseline anxiety level, what you feel most of the time,
was at a 6 on a 1 to 10 scale (1 is entirely relaxed and 10 is full
anxiety meltdown). Once these strategies become habits you’ll find
that your baseline drops, so now perhaps it is more like a 3 or a 4.
This is a marked difference and is the payoff for all your effort.
Once your overall anxiety level decreases, even if only by a few
notches, it will become even easier and faster to successfully
challenge distressing thoughts and repetitive thinking.
Take a moment as you conclude this section to tune into your
internal voice. Is it chastising you that you should do more or
reminding you of what you are doing wrong or criticizing your lack
of commitment? Remember, you do not have to do anything
written in this book. There is not a “right” or “wrong” or “should”
or “shouldn’t” approach to take you out of your anxiety struggle.
What will take you out of it is making a choice for yourself. Do you
want to live in a different way? You would not be engaging these
strategies on any level if the answer wasn’t yes. So make a
commitment to yourself to work on your anxiety each day, no
matter how small the effort. When you miss a day, just pick right
back up, no judgment, no criticizing, just pure, clear, persistent
determination.
Planning
Review the planning you started in chapter 4 (here ) and revised in
chapter 7 (here ). Reconsider how well your planning system is
working. Have you followed through with the plans you made for
yourself regarding implementing the strategies?
Consider adding to your planning approach a couple of
reminders each day on your phone or digital calendar. You might
have the reminder “breathe” in order to stay relaxed and mindful.
Or the reminder “positive self-talk” to be aware of how you’re
speaking to yourself in your own head.
Review what you learned in the last two chapters. Identify
which strategies you want to incorporate into your current plan. Try
to do your anxiety work at the same time or times each day. A
precise time provides a cue for the brain that will hasten the
“neurons-that-fire-together-wire-together” process.
Track Your Progress
One of the most powerful ways to make a new behavior into a habit
is to track what you’re doing. It’s essential to long-term progress
that you set up a system where you track on a daily basis the
strategies you’re using, and the intensity of your anxiety. As we’ve
seen previously, you can quickly and easily track progress with a
chart you sketch out in your notebook. Take a look at the example.

STRATEGY MON TUES WEDS THURS FRI SAT SUN

“Thinking ✓
about” vs.
“Experiencing”

Record Your
Thoughts
 Downward ✓
Arrow
Technique

Test Your Core

Beliefs

Identify Your ✓
Worry Triggers

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.

STRATEGY OF THE WEEK

Pick a few overarching or general strategies that you can work into
your weekly routine at least three times this week. They don’t need
to take a prolonged period of time, just something reasonably
achievable for you in the context of your life. For example, you
could incorporate the idea of “Un-Learn Helplessness” , where you
commit to taking one reasonable, actionable step to combat what is
making you anxious. Or commit to a hypothesis test and use it to
challenge at least one of your anxious beliefs.

Go Deeper
Create Your Weekly Strategies Calendar
Revisit your weekly strategies calendar you created in
chapters 4 (here ) and 7 (here ). Take a moment to look over
the current month. If you have not already done so, write in
work, social, and family commitments and appointments.
Habit formation comes faster when we teach our brain new
strategies and techniques on a daily basis. Also, anxiety is
reduced when we have a solid plan and stick to it. Write in one
strategy from chapters 8 and 9 that you’re willing to employ
every day of the month.
Assess what is coming up by digitally or manually marking
red, yellow, and green zones on your calendar. Red zones are
those that are more anxiety charged, green are those where
you expect to be fairly at ease and feel less internal pressure,
 and yellow are neutral where you imagine you will feel neither
very anxious nor very relaxed.
Take a step back and consider which red zones might trigger
anxious thinking for you. On days or times 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.

Building Your New Habits

Once you’ve been successful with a strategy, take it to the next
level. Practice the strategies on multiple occasions across a
variety of settings.
For example, if you fear eating out in public, don’t decide
to just go to the same restaurant with the same friend over and
over. Instead, challenge yourself to go to a variety of
restaurants and with a variety of people. It’s great to become
comfortable knowing that you’re no longer going to have a
panic attack in your local movie theater, but consider
branching out to other theaters in nearby towns or even going
to a play or a concert. Or if you’re working on obsessive
thinking, don’t just work on it when you’re at your place of
employment. Work to be mindful, an observer, when home
alone, when driving, even when interacting with others.
Practice the strategies across a variety of situations/people and
you’ll eventually start using them instinctively.
The more you act the way you wish you could act, and do
the things you used to avoid, and think in the ways that bring
peace of mind, the quicker new habits will form and then,
before you know it, they’ll become automatic.
Exercise: Catch Anxiety Early
Catch anxiety early, before it’s left the barn, so to speak, and
you’ll stop it in its tracks before it becomes too intense to pull
back. A way to start catching anxiety early is to develop a
quick and easy habit of checking in with yourself. So instead
of rushing from task to task, person to person—intentionally
STOP. Take time to be mindful of your ongoing experience.
Here’s how:
• At the end of the day when you arrive home, STOP before
entering. Reflect for a few moments; check in with yourself.
• When you end one encounter, STOP. What’s going on in
your body, your mind? What sensations do you notice?
• When you finish a task, STOP. Reflect on what tinges or
shifts might be happening mentally or physically for you.
Literally say to yourself, “I want to see you. What’s going
on in there?”
Tune-Ups and Check-Ins
As you move along your anxiety-recovery path, you may find
there are stretches of time when you’re no longer deliberately
thinking about the strategies. You may feel that you’re “in the
zone,” able to effortlessly manage life’s hardships.
Still, even with progress, it’s easy for us to go back to old
ways of thinking and acting. Consider placing sticky notes in
key locations (car, bedroom mirror) or reminders on your
digital calendar of the strategies that are working well for you
so you keep them top of mind and use them even when you
may not feel like you need them. Also, set a reminder on your
calendar once or twice a month to review the material in this
book and what you’ve written in your notebook (even if you
think you don’t need to!).

Goal Setting
Each time you reach a goal, consider the strategies that got you
there and if it’s possible to expand those strategies to reach
even larger goals. For example, perhaps you implemented
“total worry time” (here ) and it worked. Now that you’ve
discovered its effectiveness, consider making it a goal to do
this strategy on a daily basis. Or if you recognize that
“Watching Your Thoughts” works when under stress, consider
implementing this strategy 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.

Staying the Course

Like many things in life, success in your pursuit of anxiety
reduction and internal peace takes patience, adaptability, and
perseverance. Of course, anxiety is unpleasant and you’d like
it to stop as quickly as possible. However, habits take practice
to form and they take practice to break. Compassionately
remind yourself that there’s nothing wrong with you if you
feel that your recovery isn’t moving as fast as you’d like. And
just because it’s taking time doesn’t mean you won’t get better.
Allow yourself to adjust the strategies for your personal
brand of anxiety symptoms. One strategy may work for a
while, but it’s important to try new ones so you stay
challenged and keep growing. As your symptoms improve, the
anxiety will likely change and present itself differently. You
will need to adjust and bring new skills into your repertoire. If
the strategies aren’t working or are going only so far, then
consider individual psychotherapy or group therapy. Some
people do both. If therapy doesn’t work on its own, consider
combining psychotherapy and medication.
And, most importantly, whatever you do, don’t give up!
Allow yourself to pick the work back up again and again.
Believe in the process. Your work will pay off in the form of a
brighter future.
Resources
Online
Anxiety and Depression Association of America (adaa.org )
Social Anxiety Institute (socialanxietyinstitute.org )
American Psychological Association (apa.org )
National Alliance on Mental Illness (nami.org )
National Suicide Prevention Lifeline (1-800-273-8255)
Headspace: Meditation app
Calm: Meditation and sleep app

Further Reading
Antony, M. M. and Swinson, R. P. (2009). When Perfect Isn’t
Good Enough: Strategies for Coping with Perfectionism .
Oakland, CA: New Harbinger.
Bourne, E. J. (2015). The Anxiety and Phobia Workbook (6th
ed.). Oakland, CA: New Harbinger.
Carbonell, D. A. (2016). The Worry Trick: How Your Brain
Tricks You into Expecting the Worst and What You Can Do
About It . Oakland, CA: New Harbinger.
Collard, P. (2014). Little Book of Mindfulness: 10 Minutes a
Day to Less Stress, More Peace . Colorado: Gaia.
Hanh, Thich Nhat. (1999). 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.
References
Baltazar, N. C., Shutts, K., and Kinzler, K. D. (2012).
“Children Show Heightened Memory for Threatening Social
Actions.” Journal of Experimental Child Psychology , 112(1):
102–10.
Boswell, J. F., Thompson-Hollands, J., Farchione, T. J., and
Barlow, D. H. (2014). “Intolerance of Uncertainty: A Common
Factor in the Treatment of Emotional Disorders.” Journal of
Clinical Psychology , 69(6): 630–45.
Craske, M. G., Treanor, M., Conway, C., Zbozinek, T., and
Vervliet, B. (2014). “Maximizing Exposure Therapy: An
Inhibitory Learning Approach.” Behaviour Research and
Therapy , 58: 10–23.
Culpepper, L. (2009). “Generalized Anxiety Disorder and
Medical Illness.” Journal of Clinical Psychiatry , 70, 20–24.
Jackson, M. C., Wu, C. Y., Linden, D. E., and Raymond, J. E.
(2009). “Enhanced Visual Short-Term Memory for Angry
Faces.” Journal of Experimental Psychology: Human
Perception and Performance , 35(2): 363–74.
Jakubovski, E. and Bloch, M. H. (2016). “Anxiety Disorder-
Specific Predictors of Treatment Outcome in the Coordinated
Anxiety Learning and Management (CALM) Trial.”
Psychiatry Quarterly , 87(3): 445–64.
Katon, W. J., Richardson, L., Lozano, P., and McCauley, E.
(2004). “The Relationship of Asthma and Anxiety Disorders.”
Psychosomatic Medicine , 66(3): 349–55.
McCallie, M. S., Blum, C. M., and Hood, C. J. (2006).
“Progressive Muscle Relaxation.” Journal of Human Behavior
in the Social Environment , 13(3): 51–66.
Missig, G., Mei, L., Vizzard, M. A., et al. (2017).
“Parabrachial PACAP Activation of Amygdala Endosomal
ERK Signaling Regulates the Emotional Component of Pain.”
Biological Psychiatry , 81(8): 671–82.
Roest, A. M., Martens, E. J., de Jonge P., and Denollet, J.
(2010). “Anxiety and Risk of Incident Coronary Heart
Disease: A Meta-Analysis.” Journal of American College of
Cardiology , Jun 29; 56(1): 38–46.
Wegner, D. M., Schneider, D. J., Carter, S. R., and White, T. L.
(1987). “Paradoxical Effects of Thought Suppression.”
Journal of Personality and Social Psychology , 53(1): 5–13.
Willgoss, T. G. and Yohannes, A. M. (2013). “Anxiety
Disorders in Patients with COPD: A Systematic Review.”
Respiratory Care , 58(5): 858–66.
About the Author

Jill P. Weber, PhD, is a clinical psychologist in private practice

in Washington, D.C. She is also a psychology author and a
speaker. Dr. Weber works with teenagers, individuals, and
couples managing varying degrees of anxiety from panic
attacks, generalized anxiety, and life stress. Dr. Weber uses a
combined approach of cognitive behavioral therapy,
mindfulness, and acceptance techniques when working with
anxiety symptoms. She writes a blog for Psychology Today
and has appeared as a psychology expert in various media
outlets including USA Today, Washington Post , Nightline ,
U.S. News & World Report, and CNN. Dr. Weber is the author
of Having Sex, Wanting Intimacy: Why Women Settle for One-
Sided Relationships and the Relationship Formula series
including the titles Breaking Up and Divorce 5 Steps, Building
Self-Esteem 5 Steps, Toxic Love 5 Steps, and Getting Close to
Others 5 Steps . For more information, see
www.DrJillWeber.com.