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

You’re in the here and now. There is a fire in You feel worry and discomfort even though
the house, and you’re figuring out how to put you are not in immediate danger. No clear
it out. Once the fire is out, your fear subsides. threat is present and there is no clear way to
solve the concern.

Fear comes from real threats in the outside For the most part, anxiety isn’t created by the
world, e.g., job loss; medical diagnosis; outside world; it’s created by your mind. You
 illness of a loved one; threat of being worry about possibilities that may or may not
physically harmed; wanting to do well on a happen, such as: “What if they don’t like
specific task, such as a speech or an exam; me?” “What if the plane crashes?” “What if I
wanting to make a good impression on new can’t leave the movie theater?” “What if they
acquaintances. 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 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
LOVE 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 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
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 signifies
face, cheeks flushing, humiliation, the
social status in a
stomach sinking exposure as a fraud, situation, to
group and keeps
SHAME 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 Anxiety 1 6 7 2 5 3 5 8

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 in social

connection/closeness with people situations

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

Decrease need for reassurance Learn to tolerate fears of abandonment: positive self-
from partner 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 and being

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

Be present and participate in life No drug or alcohol use; build awareness of 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 Anxiety 1 7 3 5 2 3 6 7

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 YOU HOW TO TEST IT

I’m afraid the airplane will crash Practice relaxation exercises, visualization, deep
and I will die. breathing and then take a flight.

I’m worried about people not Go to a party, work event, neighborhood function, and
liking me, and being rejected. try to interact with people. Ask questions; don’t let
 yourself recede into a corner.

Take on a new class, work project, hobby. Build

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

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

Notice the little things: light traffic, good weather, a

The world is against me. kind person helping you in some 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
I’m useless. to help someone in your neighborhood, clean your
place of residence, clean your car, plan an activity of
some sort and follow through.

Now take one of your anxious predictions, remind yourself of why it

matters to you that you work through it, pick a strategy that will help you,
and go out in the world and test it out!

WRAP- UP
• Train the voice in your head toward self-compassion and self-acceptance.
• Replace anxious and negative thoughts with realistic thoughts.
• Make goals and take actionable steps to lessen anxious rumination.
• 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 Anxiety 3 7 9 2 7 5 3
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
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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.