The Generalized Anxiety Self-Help Program

The Generalized Anxiety Self-Help Program

In this section I offer you three steps that can be a central part of a generalized anxiety self-help program.

Step 1: How to Handle Your Worries

Let’s face it. Everybody worries some of the time. Some are quite helpful. But many worries are repetitious, unproductive thoughts that make you feel anxious or upset. They show up against your will, and you seem to have little control over them. Once you start worrying, it’s hard to stop. Often you’ll worry over things that others consider small or insignificant. And sometimes the more you try to argue against the worry, the stronger it becomes.

Whenever you have worries, your task is to handle them, one way or another.

Decide: Is This Worth Me Worrying About?

When you start worrying, the first thing to do is to distinguish whether these worries are “signals” or “noise.”

Are they “signals” that you have a legitimate problem to address or that true danger, or psychological or social threat, lie ahead? Are they alerting you to take some action? If they are these kind of “signals” then you want to pay attention to them.

Or are these worries simply “noise“: distractionsrepetitious and unnecessary, negative thoughts that make you uncomfortable. If they are noise, then you will need some special skills to stop them from intruding. You want to get that noise out of your head, to clear your mind so that you can have more enjoyable and productive days.

Any concern that you dwell on can be a signal or noise.  You have a presentation due in three days; your son is late getting home from his date; you’ve been experiencing a headache for six hours; you’re not sure whether you turned the iron off after leaving for work. If you have been having anxiety traveling lately and if you are considering driving to a new location in a few days, then your mind will probably begin to dwell on the upcoming trip. If these become repetitious, unproductive thoughts, they are worries. But are they a signal or noise?

Remember, worries as “signals” means there is some action we need to take; we can ignore worries that are “noise”.

If they are legitimate concerns (signals), we will handle them by studying the problem and taking action. If they are a noisy racket in our head, we will handle them by various techniques that reduce their annoyance. (That’s the next section.) The most direct way is to find out if a worry is a signal or noise is by attempting to make these unproductive thoughts into productive ones. In other words, treat all worries as signals until you decide that they are noise. Begin to think in a structured manner regarding your concerns.

When you hear yourself worrying, turn your attention to the details of the worries. Assume they are asking you to take some kind of action. Assume that if they are important enough to be intruding into your mental time, they are important enough to address in a structured manner. Put your worries through these four steps that lead to action.

Actively Responding to Worries as “Signals”

  1. Define your current problem, and list all the components of the problem.
  2. List all the possible solutions. What is necessary to handle each concern?
  3. Decide whether to go forward or retreat.
  4. Take action based on your possible solutions.

First, define specifically what the problem is. Sit down with paper and pencil to define the concern and its components — everything that worries you.

For example, your definition of the problem might be, “I am not prepared for the drive on Friday.” List the details under it:

  • I’m not sure of all the places to pull off.
  • I don’t know where phones are along the route.
  • I don’t know how far it is between those two exits on I-40, and I’m not sure I can handle more than a 2-mile span without an exit ramp.
  • What if I have a panic attack while driving?

Second, write down all possible solutions. Take the items on your list, one by one, and generate different ways to handle the concerns. These may include gathering more information, turning to experts or other knowledgeable people for advice, recalling your learnings from past successes, practicing skills. It can also include courageously taking actions even though you are uncertain of the outcome.

In this case, the items might include: taking a ride through the route as a passenger, identifying the pull-off locations, the phones, and the distance between those exits. Most importantly, it includes recalling any successes you have had in the past when responding to panic, identifying the specifics of how you would handle a panic attack in this situation, and practicing those skills ahead of time. Another obvious solution is to avoid the drive altogether.

Third, decide whether to go forward or retreat. Most worries have this option: you either pursue or you pull back. Worrying offers you a way to sit on the fence and not commit to a decision. So if you want to handle most worries, you need to force yourself to choose a direction.

  • You have a presentation due in three days: you cancel it, or prepare for it.
  • Your son is late getting home from his date: you wait for another half hour, or you start calling his most likely locations.
  • You’ve been experiencing a headache for six hours: you take another analgesic and wait to evaluate the problem again in the morning, or you call the doctor.
  • You’re not sure whether you turned the iron off after leaving for work: you decide it is safe to wait until you get home from work, or you return home now to check.
  • You are considering driving to a new location in a few days: you go or you cancel.

You do not have to commit to the entire action from start to finish, only to walking along the path. If driving is your concern, you can decide to ride as a passenger through the route, identifying the pull-off locations, the phones, and the distance between those exits. You can then review your choices after you have experienced that step and decide whether to take another step toward your goal. You can outline the steps you want to take if you might panic while driving. You can plan to practice those skills and even list them on a cue card for the drive. You can then decide whether to take the next step of actually getting in your car and driving.

You have a right to decide to withdraw from the action. You may have to handle certain consequences of the decision — if you cancel a luncheon date, your intended guest might be upset — but you have the right to control your behaviors instead of being controlled by others or by some strict standard of action. You get to decide what is in your best interest at this time.

And, fourth, take action based on your possible solutions. Action gets you off the fence, where worries tend to sit. Move forward from identifying the problem, move forward from thinking about all the possible solutions. Begin to act on one or more of those plans. Again, remember that with certain projects you can commit to each stage of action without committing to the final task. Review your direction toward your goal anytime you think you have new knowledge or experience that will influence your decision.

Decide: Is This an Unnecessary Worry?

Worries, like panic, take on a life of their own. When you have charted a path to walk and the noise of unhelpful thoughts follows you, then it is time to shake them. You must first take a firm stand against the worries: “These thoughts aren’t helpful. I’m not going to let them control me.” You can’t be wishy-washy about this decision.

For instance, if you believe that every panic attack is a potential heart attack, you must settle this issue before you can move forward against panic. Many people make this mistake. They have all their medical evaluations, ruling out any heart problem. They feel reassured. But each time symptoms begin, they say, “I think this is just anxiety.” Underneath that thought is, (” . . . but it could be a heart attack.”) A stronger voice is, “I’m going to treat these symptoms as anxiety. I’ve gotten a clean bill of health. I’m willing to risk the slight chance that this is something else.”

You will now learn about five ways to handle worries that are noise: stopping them, postponing them, modifying them in two ways and, surprisingly, increasing them.

Home Study

reid-wilson-book-cover-dont-panic

Chapter 15

Your Mind’s Observer

Chapter 16

Find Your Observer

Chapter 17

Take a New Stance: The Supportive Observer

Five Ways to Handle Worries that are Noise

I have adapted this technique from a procedure, called thought-stopping, that the field of behavioral psychology has applied for over twenty years. Use it when you want to dispatch quickly with intruding thoughts. This is how it goes.

Stopping Negative Thoughts

  1. Listen for your worried, self-critical, or hopeless thoughts.
  2. Decide that you want to stop them. (“Are these thoughts helping me?”)
  3. Reinforce your decision through supportive comments (“I can let go of these thoughts.”)
  4. Mentally yell “stop!” (Snap rubber band on wrist.)
  5. Begin Calming Counts.

To break such a pattern, first you must begin to notice the moments when you are focusing on Negative Observer comments (See Don’t Panic, chapter 14). Often we are not aware that our minds are rushing through negative thoughts. As you begin to pay attention to such thoughts you will start to notice these moments more frequently.

The most straightforward way to stop your doubts and worries is to do it as quickly and powerfully as possible, before they get your mind caught up in them. Once those worries strike — when you become aware of repetitive, unproductive, negative thoughts — mentally step back and observe them. Are your worries a signal of something you should pay attention to right now? Or are they just more noise in your day?

Ask yourself, “Are these thoughts helpful to me right now?” This is a great question; it will help you in a powerful way by confronting your automatic, negative thinking. Please don’t ignore it! Simply by asking the question, you have momentarily disrupted your negative thinking, which is a good move. This is your Supportive Observer (See Don’t Panic, chapter 16) in action: it notices what you are thinking and decides if those thoughts are supporting you.

If the thoughts are not helpful — if they are noise — then consciously decide that you want to stop the racket. These thoughts are powerful and will draw you to them. They are drama, and your brain seeks out drama. Let your Supportive Observer reinforce your decision with statements such as, “I’m in control of my thoughts. I don’t need to be run by these ideas. It’s OK to stop focusing on this.”

You must make a firm decision of “not now.” One way is to yell, “STOP!” inside your mind. I know that sounds like a silly thing to do. But you yell “stop” as a way to disrupt the drama of your worries. You fight fire with fire. It derails your current thought process and permits you to begin a new one.

If you need a little more stimulus to draw your attention, then wear a rubber band on your wrist. When you yell “STOP,” snap that rubber band at the same time. “Ouch!” Exactly! Now what are you paying attention to? That stinging wrist. For a split second you have left your worries and shifted to some other experience. You have created a space for a new focus of your attention.

Take advantage of that moment! Fill that space by practicing Calming Counts. (Remember that breathing technique of one deep breath and ten gentle breaths?) This will be the most effective part of your intervention, because Calming Counts will accomplish two important goals.

First, it will disrupt your typical pattern of worry. Instead of continuing to worry, you have to stop and think about how to do this highly specific breathing technique. You have to exhale all the way, take a deep breath, exhale again as slowly as possible, loosen and relax your face. Then you have to follow the next ten exhalations, counting each one, but counting backward, and seeing that number in your mind. Boy, that’s busy work! And that’s exactly what we are looking for: something to keep your mind so busy that it doesn’t drift back to your worries. Calming Counts takes about a minute and a half. That’s a wedge of ninety seconds between you and your noisy worries.

Second, you will be busy performing a technique that actually calms down your body. Calming Counts can help reverse any anxiety that starts to build in response to your worried thoughts. As you get physically calmer and as time passes, you will gain perspective on your worries and have a much easier time resisting them.

Even if your negative thoughts return a minute later, you have briefly disrupted them. This is a method of bringing your Observer to the foreground during a time of trouble. Several minutes later you may want to disrupt those negative thoughts again with a second set of Calming Counts. Slowly, you will begin to “step back” and see your worries from a new perspective. You will become less preoccupied, and your tension level will have a chance to decrease.

This technique is adaptable to many public situations. For instance, you can begin Calming Counts while waiting to give a speech. Instead of dwelling on negative thoughts such as, “Everyone will notice that my hands are shaking” or “I know I’m going to make a fool of myself,” you can preoccupy your mind by keeping track of your counts.

This same negative thinking process takes place when we anticipate facing our fears. For example, imagine you plan to attend your neighbor’s party tonight. You usually avoid such parties because you become nervous in groups. But this week you decide you will fight your fears by attending this gathering of friends. It is now 11:30 A.M. You notice that you have spent the last thirty minutes repeating useless Worried Observer comments silently in your mind: “I can’t do this. I’ll never last. What if I get trapped there? I don’t want to get trapped. I can’t go. I just can’t handle it. I’ll never last.” At this moment your Observer breaks in.

OBSERVER: “I keep repeating the same thoughts in my head about tonight. I’m scared. I’ve decided to go, but I keep thinking about how to avoid it.”

SUPPORTIVE OBSERVER: “These thoughts are only making me more scared. They aren’t helpful. I need to stop them.”

ACTION: Mentally yells “stop!” Sits down for a minute and does ten Calming Counts.

OBSERVER: “Now that I am quieter, I notice how tense my stomach is. I’m still scared.”

SUPPORTIVE OBSERVER: “Probably I’ll be a little anxious all day. It’s OK to be somewhat tense since I’m taking on a challenge tonight. I need to pace my day and keep myself fairly busy until it’s time to get ready. That’s a good way to take care of myself. I also want some support tonight so I don’t feel like I’m going through this alone.”

ACTION: Makes a list of a few worthwhile projects for the day that require some concentration. Shares concerns with a supportive person who will be attending the party. Monitors stomach tensions periodically through the day, using the Calming Breath to relax the stomach muscles when needed.

Notice what happened at the beginning of this example. I described the Observer as “breaking in” during your negative, obsessive thinking. This is probably something that already takes place within you now. You will become entangled in some negative thinking, then all of a sudden, some part of your mind will “step back” and comment on what you are doing. This is the moment you want to seize; this moment is the opportunity for change.

Begin to listen to your Observer rising up. When you notice it, keep it! Let yourself gather the facts of the moment objectively, then shift to some suggestion or plan that will take care of you and at the same time support your positive goals. If you begin criticizing yourself or making comments of hopelessness, simply notice them and then let them go (“Thinking that thought isn’t helpful to me right now.”)

An excellent stalling tactic is to postpone your worries for a bit. When you notice yourself beginning to worry, then mentally agree to pay attention to those worries. However, choose a specific later time when you will return to them.

Postpone Your Worries

  1. Mentally agree to pay attention to your worries
  2. Choose a specific time in the future when you will return to them.
  3. As that time arrives, either start obsessing or consider postponing the worries to another specific time. Whenever possible, choose to postpone.

This is like making a mental agreement with your fear. There’s a part of you that really believes that you need to pay attention to these worried thoughts. You are not about to say “no” to them. Your fear is there because it thinks it’s taking care of you. So you’re going to say, “OK, I’ll pay attention to you, just not now.” You’re going to keep the idea that you’ll actually worry. You’re going to change the idea that you have to instantly respond every time it beckons you.

How long can you postpone? Can you wait an hour? If you can’t postpone for an hour, try a half hour. Try fifteen minutes. Five minutes. Whatever it takes, try to break the automatic process of worry. That’s what postponing will do, by letting you take control over when and where you worry.

It really doesn’t matter how long you pick to start with. It’s relative to your capacity. As soon as you postpone even for 10 seconds, you’re taking voluntary control over an involuntary process. So start wherever you can, and support yourself in the effort. Use a stopwatch if you need to.

Continue to postpone as long as you can. When you feel incapable of postponing the worry any longer, then go ahead and address it. The key is to let at least some amount of time pass without worries dominating your thoughts during the practice.

Experiment with this technique a few times this week. Whatever your worries — whatever the unproductive noises are in your head — practice postponing them. In the process you will be practicing a skill that you can use in preparing for any new challenges panic offers you.

A momentary worry is not much of a problem. All of us experience them. The trouble comes with how we react to worries. If we follow those noises, if we embellish their story line, if we dwell on the details and let ourselves become upset, then we are bringing on trouble.

Here are a couple of techniques for reducing your attachment to your worries. Remember that the principle behind these techniques is that your are disrupting a thought pattern that is unnecessary, irrelevant and intrusive. You first declare that these worries are noise, then you intervene with one of these techniques. The primary benefit of these two techniques is to change your emotional response to the thoughts — to help you feel any other emotion beside anxiety.

Write Down Your Worries

How might you change your emotions toward your worries? The first way is to write them down. Carry a pencil and a small pad with you throughout the day. When you begin the noisy worries, write down your exact thoughts. If you continue worried thoughts, keep writing. This doesn’t mean a summary of what you said in your mind. This means a verbatim transcript of exactly what you’re thinking. As soon as you finish writing down the worry, if you think it again, write it down again, even if it’s verbatim what you just wrote down. Act as though you are the stenographer in the courtroom.  Every single utterance goes on paper!  Don’t write down the theme, write down every single repetition of every single worried thought.

Now what’s the benefit here? When you worry, you tend to repeat the same content again and again, right? When you write down the worries, you recognize how repetitive and senseless they are. This perspective quiets the noise. After a while you will probably experience the task — of writing verbatim all the content — as a chore. Most of us know how easy it is to mentally repeat some worry, like, “I hope this (whatever) turns out.” It’s easy to say it in your head 400 times. It’s a lot harder to write over and over again, “I hope this turns out. What if it doesn’t? Gosh, I hope it turns out. But what if it doesn’t?” There’s no way you can write it 400 times . . . it loses its power. Writing it down makes worrying into an arduous task. It becomes more work to actively worry than to let it go.

That’s how the writing will help you. After several extended writing sessions you are more likely to say, “OK, I’m worrying. Now I’m either going to start writing it, or I’m just going to let it go. I can either go through all the bother of writing these worthless thoughts, or just stop worrying right now.”

One special note: Don’t wait until you want to do this task. Few people are ever in the mood to write out their worries. Start this and other interventions because you are ready to get stronger, regardless of your mood or interest.

Sing a Worried Tune

Another way to begin changing your emotional response to your noisy worries is to sing them. (OK, stop laughing and let me explain.) Pick up a short phrase that summarizes your worry. Ignore its meaning for a while. Continue to repeat the words, but do so within a simple melody. Keep up this tune for several minutes. Whenever you feel you are less emotionally involved with these thoughts, let go of the tune and the words. Turn your attention elsewhere.

That sounds pretty silly, doesn’t it? Here you are, suffering from very distressing thoughts, and I ask you to hum a few bars. But that’s the idea. The process of singing your worries makes it difficult to simultaneously stay distressed. Yes, it’s stupid. Yes, it sounds childish. Do it anyway!!

And here’s how to do it. Pick up a short phrase that summarizes your obsession. Ignore its meaning for a while. Continue to repeat the words, but do so within a simple melody. Keep up this tune for a few minutes. Whenever you feel less emotionally involved with these thoughts, let go of the tune and the words. Turn your attention elsewhere.

I don’t expect that you will start singing this little tune and instantly feel happy. In fact, it will probably be hard to feel anything but anxiety when you start singing. But stick with it. And while you’re singing, work to become detached from the content of your song. Remember, that’s our goal.

Create a Worry Time

Do you ever find yourself worrying for days, even weeks, before an event? Your mind thinks it is protecting you by reviewing your performance, checking to see that you are going to act properly. Perhaps you worry more often about someone else. My friend is in the pre-first-ever-prom-of-the-oldest-daughter syndrome. For the next three weeks Ginger’s mom will subject herself to the common obsessions regarding prom night. “Will she be safe? I trust her, but what about those other kids? Where exactly will they be? What about all those teens who drink? And I know she won’t have sex . . . will she?”

Creating a “Worry Time”

  1. Set aside two daily Worry Times of 10 minutes each.
  2. Spend this entire time thinking only about your worries regarding one issue. (OPTIONS: speak into a tape recorder or talk to a “coach”)
  3. Do not think about any positive alternatives, only the negative ones. And do not convince yourself that your worries are irrational.
  4. Attempt to become as anxious as possible while worrying.
  5. Continue to the end of each worry period, even if you run out of ideas and have to repeat the same worries over again.
  6. At the end of ten minutes, let go of those worries with some Calming Breaths, then return to other activities.

The problem is that your mind doesn’t know when to quit; the worry begins to intrude on your daily life. The more you think about it, the more anxious you become and the less competent you are at your other mental tasks.

When this occurs, start by addressing the worries as a signal. Identify and respond to the legitimate concerns. My friend already has her prom-readiness plans set, because her worries are not just noise. She will talk with Ginger of her concerns about drinking, defensive driving, and safe sex. She will have a serious talk with the young man and get a schedule of events. And the two mothers will compare notes.

It is possible that handling the legitimate concerns will end your worries. It may at least reduce them down to a manageable level. If you still have noise left, then apply any of the skills from above: thought-stopping, postponing, writing, singing. In many situations one of them will do the trick. But sometimes you may find that your worries are too intrusive and persistent, and these aren’t enough to help you gain control.

If you are troubled by such a worry that tends to preoccupy your mind throughout the day, consider using the technique of daily Worry Time. This is a paradoxical technique — meaning that it seems opposite of logic — in which you purposely worry more instead of less. (See how irrational that sounds! That’s how you know it’s paradoxical.) Let’s say for instance that you have been uncomfortable traveling by plane in the past and you have a flight coming up. You’ve already booked the flight. It’s now about two weeks away, and you begin to worry every day about the flight, or how you’re going to handle yourself on the flight. Here’s how you would use Worry Time in such a situation.

Set aside, twice a day, about ten minutes that you have designated solely to worry about your problem. Perhaps take the first Worry Time in the morning before you go to work. Sit down in a private place and pay attention to your worries. (I’ll describe how to do that in a minute.) Then, at the end of the day, perhaps right after you get off work, sit down again and designate this as your second Worry Time.

When you sit down for this special time, totally devoted to your worries, follow these guidelines. Spend the entire time thinking only of your worries about this topic. Think of nothing positive. Do not try to convince yourself that these worries are unnecessary, do not try to see the positive side or argue in any way whatsoever. Only introduce negative thoughts, and let those continue to come up. More and more of them! As many as you have about the topic! Every angle and aspect of your worries and fears! Just let them come up in your mind, and continue to look for more of them. And try to become as uncomfortable as possible as you review these thoughts.

If, after a while, you run out of worries, recycle the worries you have already stated. Go back to the first ones and repeat them. Your goal is to spend the entire ten minutes focused on your worries, even if you have to repeat them. It is not going to work if you say, “Well, five or six minutes have gone by, and I can’t really think of anything else to worry about, so I think I’ll stop here today.”

No! Don’t do that, because there is method to the madness here. I want you to experience, eventually, the kind of frustration that comes with not being able to generate any more new thoughts. People who worry feel as if they worry all day long, but that is not actually what happens. Their worries come in little spurts — they argue themselves out of the worries, they reassure themselves that things will be okay, or they tell themselves to shut up, or they get distracted — and then the worries become quiet. But a little later the worries come back, and this battle begins again.

In Worry Time you don’t fight or struggle with your thoughts. You clear away your slate, set aside other thoughts, and give total and full attention to your worries. The result is that your worries diminish.

Why does it work? Because it helps you begin to shift your emotions when you think of the problem. During your first few Worry Times, you will probably become upset with your thoughts. After all, you are dwelling on your worst fears, and you are going over them repeatedly (like you usually do in the back of your mind at other times). But what happens when you review the same material in detail twice a day for days? After several days, most people complain about how hard it is to fill the ten minutes. They run out of things to say. Instead of feeling anxious, they get bored. Now wouldn’t that be a pleasant change!

That is one of our primary goals. Instead of thinking about a worry and instantly feeling anxious, you begin to have other emotional responses. Your body’s emergency system stops kicking in reflexively. If your worry is about airline travel, after a few days you might even catch yourself feeling good about getting to your destination more comfortably (and three days sooner than you would if you took the train).

To make those changes in your emotions you need to follow the guidelines of Worry Time carefully. For instance, don’t spend any time during this ten minutes trying to convince yourself that your worries are irrational. Do just the opposite: go ahead and let yourself get worked up. Conjure up all the negative, uncomfortable and distressful feelings that coincide with these thoughts.

At the end of ten minutes, you can let go of your worries and begin to relax. Take a couple of Calming Breaths, shake off those tensions and go about your day.

Don’t use Worry Time just once or twice. Ideally, you should place it in your schedule for at least ten days in a row. (This means if you are concerned about an upcoming event, make sure you start to worry early enough!) Expect that after several days Worry Time won’t be able to stir up such strong emotions inside you. Don’t stop then! Keep up the practice, because that’s the kind of change we’re looking for. Part of this design is for you to practice even when, try as you might, you can’t get emotionally aroused.

There are three ways you can repeat your worries during this time.

The first way is to do it by yourself, silently, by mentally repeating all your worries.

The second way, which some people prefer, is to say your worries out loud, instead of silently, even if you end up talking to yourself. That seems a little silly to people, but of course you’ll be in a private place with the door closed, so no one will be listening to you. I recommend that my patients speak their worries into a tape recorder. Recording may help you feel as though you were talking directly to someone instead of talking to the walls. If you try it this way, you don’t need to listen to the tape when you’re done. Just flip it over and record on the other side the next time.

The third way is to use a “worry coach.” This is someone who is willing to listen to your worries and support you in a specific way. Here, the worrier’s goal is to keep talking with as little assistance as possible.

The coach’s job is to offer a question or a statement only if the worrier can’t think of anything else to say. So coaches should let a few moments pass to see if the worrier comes up with another worry. If not, there are a few specific comments or questions that he or she can offer. The first one is to ask you to “say more about being worried.” The second is to ask, “What else about this topic worries you?” And third, “What other topics worry you when you think about this problem?” You can see these kinds of comments or questions aren’t that different from one another. They simply bring your attention back to the topic at hand, that is, “Keep worrying.” The goal is to discuss your worries thoroughly and passionately.

If you run out of things to say, then the coach should say, “Tell me again about those worries you’ve already mentioned.” When you begin to talk about the positive side of things, then the coach should interrupt and remind you to only speak about your worries. (Don’t get me wrong. It’s fine to reassure yourself, just not during this exercise!)

Worry Time – What the Coach Says

Coach: In this practice, the worrier’s goal is to keep talking without any assistance. Your job is to offer a question or statement only if the worrier has run out of things to say.

Say the following as often as needed:

  • “Say more about being worried.”
  • “How else does [this issue] worry you?”
  • “What else are you worried about?”
  • (If the person begins talking about the positive side) “Only talk about your worries, please.”
  • (If the person runs out of worries) “Tell me again about those worries you’ve mentioned.”

These statements and questions should be the only ones that the coach uses. Don’t let your coach get off the track by playing the “me-too” game: “Yeah, I’ve had that problem before, too. I can really understand how troubling that must be for you.” The coach should keep comments to a minimum; whenever possible he or she should just listen and nod and let you know when your time is up.

Let’s assume that you typically resist your worries or try to argue yourself out of them. How well is that working for you? If you’re like most people, it’s not working very well. It is an understandable approach, but resistance in itself may promote your worries. In Worry Time you actually support the worries. You give them space, you don’t fight them. And when you truly let them have all that space, noisy worries change. They may still be there; but if you are not fighting them, their intensity diminishes.

This is one of those techniques that you can never fully trust until you apply it. It sounds too simple to work. Let me tell you that it can work when you apply it to the “noise” of your worries.

Will Worry Time work for you? I challenge you to experiment with it just once. Choose any problem in your life these days in which you have repetitious, unproductive thoughts. Give yourself a full ten minutes of Worry Time, and see if you can even last the whole time without running out of things to say. (Follow the instructions; don’t think positively!)

I bet you won’t make it, even if it’s a problem you typically dwell on throughout the day! Because I’ll also bet that when you worry, you simultaneously struggle against the worry by trying to think more positively or by trying to stop the thoughts. When you stop struggling, and you voluntarily choose to worry, then thoughts that tended to last all day can’t even sustain themselves for ten minutes.

Worry Time and postponing can work together as a great team of skills during your day. If you have a designated Worry Time set up already, then when you begin to dwell on your worries at the office, you’ll know what to say. “At 5:15 I’m already scheduled to worry about this. I’m going to postpone this worry until 5:15. That’s the perfect time to pay attention to these thoughts.”

After you have been using Worry Time for a few days, then you may also have trouble filling that ten minutes with worries about that issue. So when your worries spring up unannounced at other times of the day, you might even end up saying, “Hey, I need this worry to fill my time at 5:15. I’m saving this thought!” By investing time twice a day to worry formally, you end up reducing the amount of time you worry during the rest of the day. And those worries begin to get so “old” that they just don’t have the punch to them anymore. It will be much easier then to say, “No, I don’t really want to think about that anymore. I’d rather [read my book, talk with friends, enjoy my day, get my work done].”

Step 2: Practice Formal Relaxation Skills

Now you will learn three methods that are useful in learning the general skills of clearing the mind and calming the body. Read these four sections below, then choose among the three techniques for the one that best suits you.

Why learn relaxation?

When a person thinks about a situation related to his anxiety, mental images activate the muscles into particular patterns of tension, as though bracing for a blow to the body. Dr. Edmund Jacobson was the first to propose that physical relaxation and anxiety are mutually exclusive. In other words, if one learns how to recognize which muscle groups are tense and can physically let go of that tension, then he will lower his emotional anxiety at that moment.

In addition, during tense times, these formal relaxation skills will help your body respond more quickly as you practice the Calming Breath (30 seconds) or Calming Counts (90 seconds).

Home Study

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Chapter 7

The Anatomy of Panic

Chapter 8

Who’s In Control?

Chapter 9

Why the Body Reacts

Chapter 16

Find Your Observer

Cue-Controlled Deep Muscle Relaxation for Anxiety

When a person thinks about a situation related to his anxiety, mental images activate the muscles into particular patterns of tension, as though bracing for a blow to the body. Dr. Edmund Jacobson was the first to propose that physical relaxation and anxiety are mutually exclusive. In other words, if one learns how to recognize which muscle groups are tense and can physically let go of that tension, then he will lower his emotional anxiety at that moment.

This first exercise gives you an opportunity to learn how you personally experience tension, and then to change that tension. Called Cue-Controlled Deep Muscle Relaxation (CC-DMR), it is based on well researched and time-tested methods for training your mind to notice the subtle cues of muscle tension — and to release that tension. CC-DMR, which takes approximately twenty minutes, trains your body’s large muscles to respond to the cues you give. Your task is to consciously notice what muscle tension feels like in specific areas of your body and to consciously release that tension. Learning this particular technique is not essential to conquering panic. It is, however, one of the best ways to learn about your tension and how to alter it. If you have learned a different technique that produces these results, or if you have already mastered this skill, feel free to move on to the next sections of the book.

When I teach a client this method, I give him or her a prerecorded audio-CD with these instructions. For your convenience, you may purchase this prerecorded CD. (See CD#1 – Relaxation) I suggest that my clients practice the exercise twice a day, every day, for one weeks, then once a day, every day, for four weeks.

Why so often for so long? Because this is a straightforward, mechanical exercise that physically trains the muscles to release their tension. At certain intervals during the exercise, you are asked to repeat a cue word, such as “loosen” or “relax.” It seems to take about five weeks of practice before the physical loosening of the muscles becomes associated with that cue word. (You will be creating new “circuits” between your brain and your muscles.) Once that learning has taken place, the muscles will be prepared to release their tensions rapidly when that cue word is spoken (along with several other “cues” that I will mention later).

There are three stages to this twenty-minute exercise:

Stage 1: Tense and then relax each muscle group. You will be instructed to tense a particular muscle group for a few seconds, then release the muscles and allow them to loosen. (ten minutes)

Stage 2: Allow all the muscle groups to loosen and relax. (five minutes)

Stage 3: Support and reinforce the muscle relaxation through imagery. (five minutes)

How to do it

Each day, find a comfortable and quiet place to practice. Take the phone off the hook or arrange for someone else to take calls. This a special time, just for you.

Begin by sitting comfortably in a chair; take off your shoes and loosen any tight clothing. Close your eyes and take three deep breaths, exhaling slowly. On each exhale, say the word “relax” silently. Or you may select a word that produces more comfort for you, such as “loosen,” “quiet,” “peace,” or “calm.”

First, you will tense and relax each muscle group once (Stage 1). During each relaxation phase, you will repeat the word “relax” (or your selected word) with every exhale.

Next you will follow in your mind a visual image of the sun warming and loosening all the muscles of your body (Stage 2). You needn’t feel frustrated if you don’t actually “see” the sun in your mind’s eye, or “feel” the sensations of loosening or warming. It is essential, however, that you maintain your attention on each muscle group as it is mentioned and imagine the possibility of warmth and loosening of the muscles. You may be surprised at your growing ability over time if you don’t try too hard. Just open your mind to the possibility of change.

During the last few minutes of the exercise you will be asked to “go to your safe place” in your mind’s eye (Stage 3). Take a moment now to picture a scene that symbolizes comfort, relaxation, safety, warmth, and the absence of outside pressures. You might imagine yourself in some location where you were relaxed in the past: a vacation spot, fishing, sitting on a mountain top, floating on a raft, soaking peacefully in the bath, or lying on a chaise lounge in the back yard. Or you could choose to create an image of your ideal vacation dream (like your own private South Seas island) or fantasy (such as floating on a cloud).

Regardless of the image you choose, spend a few minutes developing all your senses within that scene. Look around you in your mind’s eye to see the colors and patterns of the scene. Hear any sounds appropriate to the environment: perhaps birds singing, wind blowing, ocean waves crashing on the shore. You may even develop an aroma, such as honeysuckle or flowers, perhaps the salt air or the fresh odor after a rain shower. Enjoy all your senses in an easy, effortless manner. This is the kind of image you can use for your “safe place.”

At the end of the exercise, open your eyes, stretch your body, and slowly rise from the chair.

Several guidelines will help you as you begin your relaxation:

  1. The more you practice a skill, the greater your ability. So, be dedicated to this project and practice, practice, practice.
  2. During the ten seconds of tensing, tense only the muscle groups described. Let the rest of your body be relaxed and loose.
  3. Always continue breathing while you are tensing a muscle group. Never hold your breath while tensing.
  4. During each fifteen-second relaxation phase, focus on your breathing and mentally say your cue word — “relax” or “loosen” — with each exhalation.
  5. Don’t evaluate or judge how well or how poorly you do during each practice. This is not a test. Simply practicing each day, no matter what you experience, will ensure progress. You are creating new, unconscious circuits in your brain. How you feel consciously is not a measure of your progress.
  6. Some days you will find it quite hard to concentrate. Your mind will tend to wander to a variety of thoughts: “I’ve got to get back to my housecleaning.” “What should I make for supper?” “This isn’t working. I’m still tense.” “I’ve got to remember to pay those bills.” These kinds of distracting thoughts are normal; everyone experiences them. It does not mean that the process is failing.

    As soon as you notice that you have drifted off course, let go of those distracting thoughts and return to your task. Do not feel angry or disappointed with yourself. Do not let that be a reason to quit the exercise. Your body and mind are still benefiting, still learning about control, still creating those new circuits. Stay with it.

  7. You may do the exercise any time during the day or evening. It is best to avoid starting immediately after a meal, since your body is busy with digestion then and you are less alert mentally.
  8. Do not expect immediate and magical relief from the practice. This process, repeated over time, trains your muscle groups to respond to a cue.

    Some people will notice changes from the practice. You may find that you are more alert and rested, have an improved appetite and sleep better, are in a more positive mood and feel less overall tension. If any of these take place, consider them “icing on the cake.” Your primary task is to practice every day for five weeks.

  9. Some people have difficulty developing images to use during the “safe place” visualization at the end of the program. An alternative to the “safe place”, called “One Hundred Counts”, is presented in Chapter 14 of the self-help book Don’t Panic.

Imagery Relaxation for GAD

Some people find that a passive technique to quiet the mind and relax the body is more suited to their personal style. You will have two choices if you prefer a technique of this nature. One is called Generalized Relaxation and Imagery, and the second is a meditation practice.

In Cue-Controlled Deep Muscle Relaxation, you rely on tensing the muscles first as a way to experience relaxation. As an option, or for an occasional change of pace, you may want to try this twenty-minute Generalized Relaxation and Imagery exercise. In this practice you will focus only on relaxing — not tensing — your muscles. In addition, several new visual images are added to help you increase your sense of comfort and well-being as you enjoy peace and quiet.

Meditation for GAD

You may, after considering all three methods, prefer meditation instead of a relaxation technique as a way to release tensions.

Meditation is a family of mental exercises that generally involve sitting quietly and comfortably while focusing on some simple internal or external stimulus, such as a word, one’s breathing pattern, or a visual object. In relaxation, the individual engages in a number of mental, and sometimes physical, activities. In meditation, the person is physically still and has a much narrower focus of attention.

There are a number of potential benefits to learning meditation, and I will explain them later in this section. These benefits fall within two general categories. First, meditation helps you to gain control of your physical tension by eliciting the Calming Response. Studies show that during meditation, as well as during relaxation, the heart rate and respiration rate slow down and blood pressure diminishes. Over time, meditators report feeling less daily anxiety, and they tend to recover more quickly after highly anxious times. Thus within this category, meditation and relaxation provide similar gains.

The second category of benefits offers the greatest distinct contribution to those who experience panic. Learning the skills of meditation can dramatically increase your ability to control your fearful thinking by teaching you new ways to respond to your automatic thoughts, emotions, and images. The typical panic-prone person dwells on his worries, pays close attention to fearful thoughts, and responds emotionally to his negative images. Instead of being in control of these experiences, he is controlled by them.

To learn to meditate is to learn how to step away from these experiences to become a detached, quiet observer of your thoughts, emotions, and images, as though you were watching them from the outside. Anyone who has experienced panic knows that the negative thinking during panic is so powerful that you can’t simply say to yourself, “These thoughts are ridiculous. I am not about to die.” That only invites a mental argument that increases panic: “Yes, I am about to die! My heart’s racing a mile a minute. People die under this kind of stress.”

Any type of self-change strategy requires as a first step the skill of self-observation. To reduce your anxiety reaction and halt your negative thinking, you must be capable of stepping back from them far enough to put them in perspective. Chapters 13 through 16 of Don’t Panic will teach you how to gain that perspective and use it to control panic. This section gives you the foundation skills needed to implement those techniques.

There are two types of meditation that you may choose from. Since they each accomplish similar goals, you can practice either or both of them. The first is “concentration” meditation.

Concentration Meditation

The four essential features of this meditation are: (1) a quiet place, (2) a comfortable position, (3) an object to dwell on, and (4) a passive attitude.

How To Do It

Just as with the relaxation techniques, you should use a quiet place in your home or elsewhere to practice. Then, assume a comfortable body posture and begin to invite a passive attitude within your mind (meaning that you don’t need to worry about or become critical of distracting thoughts — you just note them, let them go, and return to the object you are dwelling on). The difference is that during meditation you select one object to focus on continually during the twenty minutes. You may choose a word (such as “calm,” “love,” “peace”), a religious phrase (“Let go and let God”), a short sound (such as “ahh” or “omm”), a feeling or a thought. You gently repeat that word or phrase silently at an easy pace. (For instance, if it is a one-syllable sound, you might say it once on the inhale and once on the exhale.) Or you may use your breathing pattern as the focus of your attention.

Both in meditation and in relaxation you are attempting to quiet your mind and to pay attention to only one thing at a time. An especially important skill to develop is that passive attitude. There should be no effort involved in the meditation. You pay attention to instructions, but you don’t struggle to achieve any goal. You don’t have to work to create any images; you don’t have to put any effort into feeling any sensations in your body. All you have to do is remain aware, be in a comfortable position, dwell on the phrase, and easily let go of any distracting thoughts until those twenty minutes are over. That is the passive attitude.

modification to this traditional “concentration” meditation, called “Meditation of One Hundred Counts”, is presented in Chapter 14 of Don’t Panic. It can help you remain mentally focused if you continue to be bothered by irrelevant thoughts. A second modification of this technique is a tape called “Acoustic Meditation”, which provides pleasant sounds, timbers, patterns and rhythms to enhance your ability to concentrate.

Awareness Meditation

The second meditative technique is an “awareness” meditation. In concentration meditation, you dwell on one object and consider all other awarenesses as distractions. In awareness meditation, each new event that arises (including thoughts, fantasies, and emotions), becomes the meditative object. Nothing that rise up independent of your direction is distraction. The only distractions are the comments that you begin to have about what you see, hear or feel.

How To Do It

The process is as follows. Find a quiet place to sit comfortably for twenty minutes. Begin by focusing on your natural breathing pattern. Mentally follow each gentle inhalation and exhalation, without judgment and without comment. (Those who become anxious when attending to their breath may focus on a single word or sound instead.) After a few minutes, allow your attention to shift easily among any perceptions that rise up. As each new thought or sensation registers in your mind, observe it in a detached manner. As you observe it, give that perception a name.

For instance, in the first few minutes of meditation you are focusing your awareness on each breath. As you loosen your attention you soon notice the tension you are holding in your forehead muscles. Without effort or struggle, subvocalize a name of the experience — perhaps “tension” or “forehead tension” — and continue observing. Eventually, your perception will shift. As your detached observing mind follows your awareness, you take notice of a mental image of a man’s face with the corners of his mouth turned downward. Do not become involved with the image: don’t analyze its meaning or wonder why it appears. Simply notice it and name it — “frown” or “man, sad face” — while you maintain your uncritical perspective.

When you do become lost in your thoughts, involved in emotions or focused on a decision, return your full concentration to your breathing pattern until you regain your detached observer. Everyone gets caught up in their experiences from time to time during meditation. Don’t be self-critical if you continually drift off and fail to expel those perceptions. In concentration meditation you merely relax, let go, and focus back on your meditative word. In awareness meditation you relax, let go, and follow the flow of your perceptions from a distance. What you observe is not important. How you observe is the key: without evaluation and without involved comments.

What You Can Learn from Meditation

You needn’t become a skilled meditator to gain benefits from meditative practice. In fact, highly anxious people will find that the two relaxation techniques are easier to follow, and they may wish to choose one of those as a long-term method to relax their muscles and quiet their mind.

However, it is the process of practicing meditation that provides the valuable understanding that you can directly apply to controlling panic, even if you only practice the technique for several weeks.

Consider that during panic we become consumed by our momentary experience. We notice the unpleasant sensations in our body and become frightened by our interpretation of their meaning (“I’m going to faint,” or “I won’t be able to breathe.”) We notice our surroundings and become frightened by how we interpret what we see (“There’s no support here for me. This is a dangerous place right now.”) We reinforce these sensations and thoughts by conjuring up terrifying images of ourselves not surviving the experience. Most of our thoughts, emotions, and images are out of proportion to reality.

To gain control of these moments we must become skilled at disengaging from our personal distortions.

We will not develop this skill by waiting until our next panic to practice. By then it’s too late, because panic has control. The best time to learn a basic skill is during non-anxious periods. Then, we introduce that new skill gradually, over time, into the problem situation.

Here are the valuable learnings you can glean from meditative practice:

    1. Meditation is a form of relaxation training. You learn to sit in a comfortable position and breathe in a calm, effortless way.
    2. You learn to quiet your mind, to slow down the racing thoughts, and to tune in to more subtle internal cues. You acquire the ability to self-observe.
    3. You practice the skill of focusing your attention on one thing at a time and doing so in a relaxed, deliberate fashion. By reducing the numbers of thoughts and images that enter your mind during a brief period, you are able to think with greater clarity and simplicity about whatever task you wish to accomplish.
    4. You master the ability to notice when your mind wanders from a task, to direct your mind back to the task, and to hold it there, at least for brief periods. At first there may be a longer time span between when your mind wanders and when you realize it. With continued practice, you learn to catch yourself closer and closer to the moment in which you lose track of your task.
    5. Through meditation you desensitize yourself to whatever is on your mind. You are able to notice your personal fears, concerns, or worries and at the same time step back and become detached from them. In this manner you can learn about your problems instead of being consumed by them.
    6. If you regularly practice meditation and are able to feel more relaxed during that time, you gain the experience of mastery: your voluntary actions produce pleasurable changes in your body and mind.
    7. As you acquire the knowledge of how you feel when you are calm, then you can use that feeling as a reference point during your day. For instance, if you feel calm after meditation in the morning, you will have a greater chance of noticing the subtle cues of tension later in the day. In other words, meditation (as well as relaxation) helps you become more alert to what circumstances are stressful in your life. You then have time to intervene in your circumstances before your tension builds to uncomfortable proportions.
    8. In the upcoming steps you will learn the importance of noticing your thought process leading up to and during panic. You must develop the sensitivity:
      1. to notice those thoughts,
      2. to then let go those thoughts, and finally,
      3. to turn your attention to some specific supportive tasks.

That is no simple feat! By practicing meditation you practice those three steps without simultaneously struggling with the frightening experience of panic.

  • Some people attempt to overcome the anxious thoughts leading up to panic by replacing them with positive thoughts. For instance, if they are thinking, “I’m about to lose control and go crazy,” they will begin to simultaneously tell themselves, “no, I won’t. I’ve never gone crazy before. I’ll calm down soon.” Sometimes this is quite a successful strategy. At other times, though, it can backfire by producing an internal quarrel. In arguments, of course, we tend to “dig in” to defend our position, and that’s what can happen here: the fearful thoughts only get stronger. A central strategy you will learn in the coming steps is first to stop those fearful comments completely by shifting your attention to some neutral task. Then, after disrupting your fearful thoughts for a few seconds or a few minutes, you will be better able to introduce positive, supportive suggestions without risking the internal battle. The two meditative techniques in this section (“concentration” and “awareness”) teach you this basic skill. In Step 3: Practicing Your Breathing Skills, you learned two of these disruptive processes — Calming Breath and Calming Counts — which are similar to brief forms of meditation.

Step 3: Practice Your Breathing Skills

During an emergency, our breathing rate and pattern change. Instead of breathing slowly from our lower lungs, we begin to breathe rapidly and shallowly from our upper lungs. If during this time we are not physically exerting ourselves, then it can produce a phenomenon called hyperventilation. This in turn can explain many of the uncomfortable symptoms during panic: dizziness, shortness of breath, a lump in the throat, tingling or numbness in the hands or feet, nausea, or confusion.

The good news is that by changing your breathing you can reverse these symptoms.

By shifting your breathing rate and pattern, you can stimulate the body’s parasympathetic response. This is the body’s equally powerful and opposite system to the Emergency Response and is often called the relaxation response. For our purposes I will call it the Calming Response.

The table below lists the physical changes that take place in the Calming Response. As you can see, all of the primary changes of the Emergency Response are reversed in this process. One of the differences in these two physical responses is that of time. The Emergency Response takes place instantly in what is called a mass action: all the changes occur together. Once we flip on that emergency switch, it takes awhile for the body to respond to our calming skills. For this reason it is important for you to know what specific skills will reverse this emergency response and will help calm your body and clear your mind.

The Calming Response
(Parasympathetic Response)

  • oxygen consumption decreases
  • breathing slows
  • heart rate slows
  • blood pressure decreases
  • muscle tension decreases
  • growing sense of ease in body, calmness in mind

You will now be introduced to three breathing skills. In later steps you will learn how to change your fearful thinking and your negative imagery, because each time you frighten yourself with catastrophic thoughts or images, you re-stimulate your body’s emergency response. To begin with, however, you need a solid foundation in proper breathing.

As you apply these skills, keep two concepts in mind.

First, our breathing is dictated in part by our current thoughts, so make sure you also work on changing your negative thoughts, as well as your breathing, during panic.

And second, these skills work to the degree you are willing to concentrate on them. Put most of your effort into not thinking about anything else — not your worried thoughts, not what you will do after you finish the breathing skill, not how well you seem to be at this skill — while you are following the steps of these skills.

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Chapter 16

Find Your Observer

Natural Breathing

The first breathing skill is called Natural Breathing, or abdominal breathing. In fact, this is a good way to breathe all day long, unless you are involved in physical activity. In other words, you should practice breathing this way all day long, since it provides for sufficient oxygen intake and controls the exhalation of carbon dioxide.

It’s very simple and it goes like this:

Gently and slowly inhale a normal amount of air through your nose, filling your lower lungs. Then exhale easily. You might first try it with one hand on your stomach and one on your chest. As you inhale gently, your lower hand should rise while your upper hand stays still. Continue this gentle breathing pattern with a relaxed attitude, concentrating on filling only the lower lungs.

How to Do Natural Breathing

  1. Gently and slowly inhale a normal amount of air through your nose, filling only your lower lungs. (Your stomach will expand while your upper chest remains still.)
  2. Exhale easily.
  3. Continue this gentle breathing pattern with a relaxed attitude, concentrating on filling only the lower lungs.

As you see, this breathing pattern is opposite of that which comes automatically during anxious moments. Instead of breathing rapidly and shallowly into the upper lungs, which expands the chest, you breathe gently into the lower lungs, expanding the abdomen.

Calming Breath

The second technique is deep diaphragmatic breathing and can be used during times when you are feeling anxious or panicky. It is a powerful way to control hyperventilationslow a rapid heartbeat and promote physical comfort. For this reason we will call it the Calming Breath.

Here’s how it goes:

How to Do Calming Breath

  1. Take a long, slow breath in through your nose, first filling your lower lungs, then your upper lungs.
  2. Hold your breath to the count of “three.”
  3. Exhale slowly through pursed lips, while you relax the muscles in your face, jaw, shoulders, and stomach.

Practice this Calming Breath at least ten times a day for several weeks. Use it during times of transition, between projects or whenever you want to let go of tension and begin to experience a sense of calmness. This will help you become familiar and comfortable with the process.

And use it any time you begin to feel anxiety or panic building. When you need a tool to help you calm down during panic, you will be more familiar and comfortable with the process.

Calming Counts

The third technique is called Calming Counts. It has two benefits over Calming Breath.

First, it takes longer to complete: about 90 seconds instead of 30 seconds. You will be spending that time concentrating on a specific task instead of paying so much attention to your worried thoughts. If you can let time pass without such intense focus on your fearful thoughts, you will have a better chance at controlling those thoughts.

Second, Calming Counts, like Natural Breathing and the Calming Breath, help access the Calming Response. That means you will be giving yourself 90 seconds to cool your body out and quiet your thoughts. Then, after that time has passed, you will less anxious than you were.

Here’s how this skill works:

How to Do Calming Counts

  1. Sit comfortably.
  2. Take a long, deep breath and exhale it slowly while saying the word “relax” silently.
  3. Close your eyes.
  4. Let yourself take ten natural, easy breaths. Count down with each exhale, starting with “ten.”
  5. This time, while you are breathing comfortably, notice any tensions, perhaps in your jaw or forehead or stomach. Imagine those tensions loosening.
  6. When you reach “one,” open your eyes again.
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