Anxiety Disorder Workbook

Survival Tips for Reducing Anxiety and Stress

Mary Ellen Popkin

Copyright ©2002

ISBN: 1-58749-287-3

CONTENTS:

WHY I WROTE THIS BOOK

INTRODUCTION

LESSONS

LESSON 1-RELAXATION EXERCISES

LESSON 2-JOURNAL WRITING

LESSON 3-REPLACEMENT THOUGHTS

LESSON 4-SCARY OCD THOUGHTS

LESSON 5-DISTRACTION TIPS

LESSON 6-BEING ALONE

LESSON 7-SAFETY KITS

LESSON 8-DRIVING TIPS

LESSON 9-VOCABULARY CHANGES

LESSON 10-DOING IT ANYWAY

LESSON 11-STOP LOOK LISTEN

LESSON 12-HOW TO MANAGE YOUR DAY

LESSON 13-SAYING NO

LESSON 14-LETTING GO OF GUILT

LESSON 15-FORGIVING YOURSELF

LESSON16-FORGIVING OTHERS

LESSONS 17-SET BACKS

LESSON 18-GROWTH SPURTS

LESSON 19-VISUALIZATION

LESSON 20-SETTING GOALS

IN CLOSING

Why I Wrote this Book

Terror struck me out of nowhere. I was heading home from college one weekend, like I had done many times before. But this trip was different. My heart was pounding and my legs shook uncontrollably. As I approached the toll on the Garden State Highway, a million thoughts seemed to go though my head. I actually thought it would explode. For the first time I can remember, I felt like I couldn't make a decision. With my foot still shaking on the accelerator, I lifted it to slow down as I approached the toll both. Could I even get a quarter out of my change holder to throw in the bucket? Should I continue going home or should I turn around and head back to the dorm? What was I going to do? DECISIONS.

I managed to take my shaking foot off the accelerator and apply my left foot to the brake. Now I was at the toll booth, quarter in my sweaty hand. Why was it sweating so? The crazy thought passed through my head that if I threw that quarter into the bucket, no one would know why I was feeling this way. For some reason I believed I must have been drugged. But when? Was it an hour ago before I left school? There was no one I knew who would do such a thing, anyway. And why would this quarter give doctors the answer to what I was feeling now? I must have chosen four or five quarters to discard in the toll bucket. Finally I was committed, now, to continue to the next toll booth. With each toll booth I performed the same ritual of selecting the right quarter to toss. My legs never stopped shaking, my palms seemed ever sweatier. My heart felt like it was in my throat. How could I possibly make it home? I reassured myself with each toll that I was one more toll booth closer to home. Closer to safety, I said to myself. I passed four toll booths that day just like I had done many times before, but this was the first time I had an anxiety attack.

Finally I arrived at the turnpike, but there were two ways I could take to go home. I couldn't decide. Do I take the turnpike? Or should I take Route 1? Never before had I faced such indecision. If I took the turnpike, which would be faster? I would have to grab a ticket and pay a toll. After the extreme anxiety I just had paying tolls, I veered the last second to take Route 1. At each landmark I told myself I was almost home. At every red light I wanted to jump out of the car and scream for help. But surely if I did that, they would lock me up. So instead I stayed filled with terror inside my car. Finally, those decisions of whether to go back to the dorm or which quarter to use for paying tolls was behind me. Legs shaking, trying to stay focused on the merging traffic, I continued to drive. Finally my exit. For some reason my palms were still sweaty, my heart was still racing, and my legs were still shaking. The only difference was that my thoughts weren't racing quite as much. Now all I had to do was stay focused on the road so I could make it to home and safety. As I pulled in the driveway I almost collapsed from fatigue. My strong athletic legs seemed to be mocking me. They shook and buckled as I tried to get out of the car. I tried to run to the front door but my legs only let me walk. And with my brain stressed to a debilitating fog, I could hardly put one foot ahead of the other. Honestly, I wanted to kiss the front steps, but I chose to stagger inside the front door instead.

I don't remember the rest of that day because all I wanted to do was sleep. However, I do remember on Sunday when I had to drive the same road back to school that I was filled with fear. Never before did dread hit me when I had to drive. I had been driving since I was sixteen. This was as natural as walking. But not anymore. Fortunately, I chose to take Route 1: No tolls. Wow, I was able to make a decision. I picked out my four quarters for the Garden State Parkway tolls before leaving home. Yes, with some preplanning I just might be able to do this task. It was still difficult to throw them in the bucket, but with each one tossed I would tell myself I was closer to school. The next few times I had to drive from college to home and back again I had some apprehension, but never again did I experience a full blown anxiety attack on that trip. Looking back, I am so grateful I didn't, because I might have chosen to drop out of college. I would learn later that anxiety can lead to avoidance behaviors, so I felt blessed. I had managed to hold off the avoidance behaviors that time. For years I filed that first attack away in my memory banks. It was not until after graduation that I would have to remember that horrible ride.

The following year I would graduate from college and once again the anxiety monster would come back, this time to stay. My college graduation was stressful for many reasons. The major stress in my life was my father dying of cancer. He would not be able to attend my graduation ceremony. He never did see Marmot College because he was sick from the cancer during my college years. But I never thought how much it would affect me on graduation day. To be honest, I didn't even want to go to the ceremony. But my mother was so proud, she didn't want to miss it. As luck would have it, Dad was in the hospital that weekend, so we all could go to the ceremony. I dreaded it, truthfully.

My brother-in-law and sister and mother went to watch me receive my diploma. On the way back home my brother-in-law pushed the speed limit to get to the hospital. My sister offered words of comfort and support because I was so stressed. With their support I made the more than two-hour ride for the final ride back home. This time I didn't mind my brother-in-law pushing the speed limit. He was doing it to make it to the hospital before visiting hours were over. For me the speed meant I would be in a safe place sooner. We made it just minutes before visiting hours were over. When I showed Dad my diploma, he was so thrilled. The next day he was released and the real work began. I remember Mother and I picking him up from the hospital. He was so frail and weak. And the pain medicines made him irrational. I thought, at least he has an excuse, but why was I so irrational? He was nothing like the images I still carry around of my Father. He was the dad who could do anything. So strong and independent. My Mother wanted me to go away to graduate school. I even had an offer to interview for a job in Washington, DC. Either would have been fine with her as long as I left home. There was a pleading tone in her voice. I didn't understand at the time she wanted to protect me. Later I learned she quit her job around my age to care for her mother who was dying of cancer. A mother's protective love. She desperately wanted to spare me what she knew would be a difficult task. Although she knew she would need help caring for Dad, she wanted to spare me. I decided to compromise. I found a job teaching in a nursery school near home. When I told my dad, I wasn't prepared for his tears. He pleaded with me to stay home and help Mom care for him at home. I declined the job and took on the hardest job of my life instead.

Of course I was young and felt so confident that I could handle any situation. Oh how naive I was at that time. But, I had just completed a four-year degree at the top of my class. How hard could this be? The daily strain of watching a loved one die was one of the hardest and most rewarding things I have ever done. The panic attacks made me feel like I was going to die, pass out or go insane. Why was I tense all the time? Why was I having attacks three to four times a day? This was beyond my comprehension. Confident I was going insane, I didn't even know I had an anxiety disorder. It's comical now when I think how I searched for answers in Freud, Sartre, Kierkegaard, Dostoevsky. Existentialist reading became an obsession with me. There had to be an answer in there somewhere. I wasn't looking hard enough, I told myself. How far off the track to seeking a solution I was by devouring these books, I would only realize years later.

It became easy for me to avoid going out. Since my father needed someone home with him all the time I naturally volunteered. I hid my agoraphobia so well all those months. But when he finally went home to the Lord, I had to tell my mother my well kept secret. I had to tell her I was terrified to go to the mailbox, to eat a full meal, to be alone, and to even sleep.

I remember those days so vividly. The attacks and the avoidance sneaked up on me in stages. One time we took Dad for an hour ride through the countryside. On the way home he was losing blood through his urine. This was very obvious because he had a catheter and I gasped as I saw it filled with dark red blood. He was also slipping in and out of consciousness. I was in complete panic until we made it to the hospital near home. All I could think was that I had to stay sane until we got there. My mother would never have been able to find the way to the hospital. She could drive but needed someone to tell her the way. That someone would have to be me. I knew if I could suppress the anxiety, we would all be safe. It always amazes me how we can push back an attack in crisis. However, the anxiety will come out eventually. Now I was frozen with fear anytime I had to drive. What if I couldn't drive? What if I forgot my name? What if no one would help me?

But that day as we sat in the ER I felt so in control. I use the word "control" because as I look back over this time in my life I learned that a lot of anxiety is a control issue. It is the need to have control or the fear we will lose control. Up until that point I knew if I studied a certain amount of time I could get a passing grade. With more effort I could make the honor roll. Also, much of my younger life was spent studying ballet and ice-skating. Hours were spent in training. With persistence (and tons of falling down on my butt) I knew I would eventually master that new jump I was constantly working on. There was always the sense that a certain amount of effort would make any goal possible. This reality, the reality I based most of my life on now, changed with my father's terminal illness. There was no amount of effort that could stop his dying. So for the first time in my life, I felt completely out of control. (I feel it is important to mention the control issue again. We need to find acceptance with our anxiety disorder. I firmly believed if I had accepted my limitations and circumstances, I would not have suffered as long.) Acceptance does not mean being a quitter or a victim. Actually, acceptance enables you to move forward. When I realized that making my father's last days more comfortable was the goal I felt more in control. This was actually doing something positive.

The dreaded and feared day came as he passed away around 2 A.M. on March 4, 1985. All those fears that I would die or go insane didn't come to pass. This should have proved to me that most of what you fear doesn't happen. So much emotional energy is wasted. Of course, I generally learn the hard way. I was unusually calm at the funeral. Even the 30-minute ride on the turnpike to the grave site passed effortlessly. I didn't realize it at the time but the body has a natural healing response. When the stress becomes overwhelming, your body shuts down. I had that out of body, floating feeling. At this point I was not afraid of that feeling. In the past and again in the near future it would cause me unnecessary anxiety. But, that day it was my friend, not my enemy. It would only be much later that I would learn it would be my friend.

During my father's illness I did manage to do some positive things to relieve the anxiety. It's amazing how naturally you discover some techniques when you're desperate.

We had the cleanest house in town. I did all types of odd jobs around the house. I remember ripping up the basement tile floor because it needed replacing. The work was rewarding and physically draining. Most important, it lessened my anxiety. When I was in the basement working hard physically, I felt free from anxiety. I took the aggression and anger I felt over having this disorder, out on the tile floor. With each tile I ripped up it seemed I was ripping out my anxiety. At this point in my life I couldn't sit still. I had generalized Anxiety Disorder, but I didn't know it.

I remember when I tried to make a tiffany lamp. I cut the glass to fit the templates. I used a grinder to smooth the edges. This project, which I started over 18 years ago to help me relieve stress, never got finished. I never did use the copper foil and solder to put that lamp together. Actually I left it behind when my mother sold the house. It really doesn't matter that it was never finished. That project gave me hours of relief from the anxiety. It served its purpose. For the longest time I berated myself for not finishing a project. I was taught you finish what you start. It was clear I needed to relearn some old concepts.

There were positive moments during that time. For example, I knew all of us needed a holiday. If we couldn't get one physically, then we would take a mental one. Our home had these beautiful bay windows with a view of the Delaware River. Growing up, we would spend our summers at the Jersey Shore. Those were happy, carefree times. One day I got this bright idea to throw a beach party in the living room. We moved Dad to the couch in front of the windows. Mother wore a sun dress and I put on a bathing suit. I spread out beach blankets and made ice tea, (today I would have made decaffeinated but I was still learning). We took a mental escape to the Jersey Shore. When the hospice workers came to check on Father, they said it was a wonderful idea. Some of my parents' friends thought I was a bit silly. But another lesson you learn along the way is not to worry about what people think. If it is legal, moral, or ethnical and it doesn't hurt anyone, why not?

So many hours were spent in total fear. However, I did manage to read Moby Dick to my Father as he lay racked with pain in his bed. These were the things I could do to bring some joy. I don't know if he followed the book but he would comment how wonderful it was that I could read it to him. It brought me some peace and, for some moments, anyway, it helped Dad escape from his chronic pain. If only I knew then that my job was not to cure him of cancer. It was to be there and share time with him. Maybe then the anxiety wouldn't have been so intense. But we tend to be very hard on ourselves, all to often expecting perfection when perfection isn't possible. We want to fix every problem, control every situation, and even know what the future holds for us. This is not possible. The sooner we accept this, the less unnecessary anxiety we will experience.

When my father finally left this earthly plane and all his physical pain behind, it was comforting for me. But now I was stuck in a crazy world of anxiety disorder once again. Filled with fear, I knew I had to tell my mother about my secret.

Fortunately, my mother was very understanding and tried to help. I remember how confused she looked the day I told her. Who wouldn't? Imagine your daughter telling you how afraid she was to drink or eat an entire meal. Why? Well, I tried to rationalize the irrational. I explained to my mother that perhaps the food was poisoned. I was afraid that if I left just a little bit of food on my plate, someone might discover why I became violently ill or died. (Yes, I realize this makes no sense.) She sat with me for hours, both of us taking sips of water until I was able to finish an entire glass. Together, we celebrated this accomplishment. However, in the back of my mind I knew something bad was still going to happen. Somehow, this time the fates passed me by, but they would surely get me one day. If I was sane 20 minutes after I ate or drank something, I felt relief. That was my magical time frame to beat the fates. Sounds a bit superstitious? I was never a superstitious person, but this disorder does some odd things. Control was at the core of my new-found superstition. I was fixated on the number “20”. At 20 to or 20 past any hour, I didn't want to do anything. At that point in my life that time of day was the witching hour. Later, I learned it was OCD (Obsessive Compulsive Disorder). At the time it was just another name to add to my growing list of anxiety symptoms. My days were often broken up by these times. I would stress the most at 19 minutes until the hour. By 21 minutes after the hour I seemed to relax a bit. However, the other symptoms of GAD, Anxiety Attacks, and Agoraphobia were still present. Looking back, it seems silly to me now, but at the time it was my "reality." Yet, I still see how I was trying to rationalize my irrational world.

Superstitions have been used for centuries to rationalize irrational events. Maybe this is a genetic throwback. I also spent a lot of time trying to figure out the how and why of this disorder. When I went into the practical, facing it head on, the real progress began. If you are having bizarre thoughts or behaviors, realize it is just a byproduct of the anxiety. It will improve and many of the behaviors will disappear with time.

Eventually, Mother persuaded me to see a counselor. I was terrified to go.

Not just because it meant leaving the house. I felt certain I was insane and beyond cure: a hopeless case unlike any other patient. To my relief and surprise, the therapists said I was suffering from separation anxiety. Still, in the back of my mind, I knew I was insane and beyond hope. Just wait until I got the courage to share with the therapists those obsessive scary thoughts that bombarded me daily. Thoughts such as, I will forget my name. Maybe the food I'm eating is drugged or poisoned. The number “20” has mystical power. As I built up confidence with my therapists and myself, I slowly shared my secrets. All too often we hide our disorder. We are afraid we are insane. Then we become afraid we will be judged, rejected or considered a nut case. (It is always a personal decision when and who to share your disorder with, but please do seek help.) Once I started to venture out in the car, I remember having the constant thought that the person riding with me would just disappear. Who was going to take them I had no idea. Martians maybe? As I said, when you look back it seems funny. But at the time it was my "reality," and a scary one at that. I particularly remember a time when I was venturing out with my mother. We used to drive over two hours to the shore every weekend. One time I had a massive panic attack when we were halfway to the shore. Halfway points are often a source of high anxiety for me. There is this voice inside that says you now made a commitment to this trip. It will take you as long to go back as to go forward. I pulled the car into a gas station. I ran up to a vending machine, all the while fidgeting for coins I could toss into the machine. Yes, I still obsessed about discarding coins. I purchased an ice cold can of Coke. My palms were sweaty, my heart was racing, and I was having a hot flash. Convinced I would spontaneously combust, I ran back to the car. I told my mother in a high pitched frantic voice that we had to go home...NOW. She calmly replied, "OK, but we are halfway to the shore." Sitting behind the wheel, I held the cool, smooth can of pop to my head. It was so calming and soothing. All I could feel was the ice cold can on my hand and forehead. I didn't realize it then, but I had discovered yet more tools to fight my anxiety.

My mother gave me a choice. I had an out. I could go home if I wanted to and not quit. I also had something contextual. I could feel the ice cold can. My awareness now shifted to the can, and the coolness of it. It actually made my hand hurt, it was so cold. Slowly I looked at the steering wheel and the interior of the car. Lastly my eyes gazed on the road which lead to the shore. Frantically, I put the car in drive, stepped on the gas and chose to continue on the road to the shore. Anxiety remained with me, but I was halfway to the shore and with my foot on the gas pedal I was getting beyond that halfway point every second. I couldn't be home that second anyway, and with each mile I was closer to the shore than to home.

You can't imagine how wonderful it felt to finally arrive at the shore.

Accomplishing your goal while fighting anxiety at the same time gives you a strong sense of achievement. Now, on long trips, I freeze water before I travel. I can either put it on my head to cool me off, sip the ice cold water or both.

Going back to work was a major trauma as well as triumph for me. After my father passed away I spent the next five months, recuperating from grief and chronic anxiety. Angry that this disorder had stopped me from pursuing a career, I decided to channel that anger. There was a challenge to overcome: I was terrified to travel alone. What does an agoraphobic do? Well, I chose to go to a temporary agency for work. I remember my mother driving to the agency with me. I told the girl who interviewed me that my main concern was transportation. Little did she know the real reason why. She found me an assignment just one mile from home. I was so happy. Also, the commute to work was a straight ride. For some reason, any turns made traveling even harder. Maybe I feared my brain wouldn't remember how to make a left or right turn. How different I was than just a year before when I would travel up to Maine and down to Virginia from Pennsylvania by myself. At that time, traveling, especially traveling alone in my car, was a sanctuary. Now it was a house of horrors. That first day at work I got behind the wheel of the car. With palms sweating and legs shaking, I backed out of the driveway. I drove that mile praying every second. As I pulled into the parking lot, my anxiety level lowered a bit. Progress, even a little bit of progress, was sweet.

In approximately two or three months I grew tired of that assignment. I asked the temporary agency to give me another placement. Of course, I again asked for an assignment close to home. This time I had to make a few turns, but the distance was about the same. Progress was being made but again I became bored with the assignment. This disorder was ruling my career. Ever work choice was made by travel, not job description. My sister was working at a day care center and she told me about an opening. It was a fifteen-minute commute but it only had two turns. Plus, I would have a safe person once at work there: it would be my sister. Could I do it? They wanted to hire someone as a substitute teacher. I loved the idea of teaching children. After anguishing over the commute to the new work place, I decided to take the job. They said they would call me daily if I was needed. That helped me accept the job. I told myself that if they called me on a high anxiety day, I could always say I was ill.

Little did I know they would need me daily. I was given a regular work schedule but thinking I had an “out” helped me accept the position. My first day on my commute to work I had a Seals and Croft tape playing in the car. It took me about four or five songs to get to work that day. From that day on I played the same tape from the same spot going to and from work. Unwittingly I had learned another coping technique. I would not think of the minutes or the miles; I would count the songs. Just two more songs and you are there, I would tell myself. Only one more song. You can do it, I'd urge myself. I must admit that sometimes those songs seemed to drag on for hours instead of minutes, but this method did work.

That was a major breakthrough for me and lead to other work, work that would require even more travel. I felt like a bird that had just learned how to fly. Not only was I teaching nursery school during the week, but on Saturday I was coaching ice skating. On the weekends I often traveled to places with my mother. While on vacation I took my mother 3,000 miles all the way to California. I remember on the way back home I woke her up in Wyoming with a massive panic attack. I said we have to get home...NOW. Home was over 2,000 miles away in Pennsylvania. It was about three or four in the morning. We packed up the car and I drove like the wind until the anxiety faded. We did get to see the sunrise in Wyoming. It was a memorable sight, so I guess the anxiety attack inadvertently produced a positive. It is best if you look for the positive in anxiety situations.

Eventually, ice skating became a full time career. Anxiety attacks and travel challenges still existed, but I wanted to choose my career instead of the anxiety choosing it. There were days when I lied and said my tire went flat. Actually, I couldn't force myself out of the house. The people I worked with didn't know I had anxiety disorder. Fear of judgment stopped me from sharing. After about eleven years I left that career for one in financial services. I remember when the regional vice president of the company interviewed me for the job. I started to cry. It involved travel and public speaking. I told her about my disorder and confessed I wasn't sure I would be able to perform my duties. I would be working with her directly most of the time. To my surprise she was so wonderful. She knew a little about anxiety disorders. We became dear friends and our work relationship was wonderful.

One day my boss told me we would have to fly to Atlanta for a convention. I was terrified. She changed her flight plans to travel with me. She had a close friend who was a psychiatrist. He gave her tips on how to keep me sane on the plane. When she picked me up to go to the airport, she had a safety kit. It was filled with playing cards, drawing paper, pens, word searches, lifesavers and magazines. Right before the plane was about to taxi I almost screamed out loud, “I have to get off...NOW!” As the stewardess stared at us, she tried to reassure everyone in the plane that I would be OK. I chose to put my head between my legs. How silly I must have looked. Once the plane was up in the air and flying level, I started to calm down. I wish I could say the rest of the trip was free from anxiety but I had other situations to face once we landed in Atlanta. We attended lectures in extremely large convention buildings. There were masses of people everywhere. There were rides in taxis, rides over which I had no control. Most of the time I felt spaced out or terrified. One of my most vivid memories was looking for all the exits wherever we went.

But to my amazement I survived the convention. Before I knew it, it was time to board the plane again. And once again that anxiety monster hit. On the plane ride back we were seated next to a man we didn't know. Once again I wanted to flee the plane. My boss calmly explained to him that I was afraid of flying. He asked how he could help to calm me down. He wasn't afraid of flying but he kept my mind occupied by telling me about his days in the Navy, hanging off the side of his ship. He described how he sat in a tiny seat as he attempted to keep his balance as he worked to clean the huge ship. Below him was the menacing ocean. This man understood fear. OK so his fear was more rational than mine, but it still helped me as he empathized with my situation.

As the attacks would start to creep up on me, my boss and our kind seat mate would ask me questions about teaching ice skating. My boss had a psychiatrist friend, and before our flight, the psychiatrist had given her tips on how to divert my attention should I experience anxiety. It worked. People really can be so kind at times. I remember rambling on about how to do a certain jump or spin. Talking about edges and even trying to draw pictures on the paper as I rambled. Both of them had to be so confused by my skating lecture but it did calm me down. They achieved their goal to refocus me. I learned that my mind couldn't focus on the anxiety and another topic at the same time. Finally the anxiety passed. The three of us were so excited that my anxiety passed. The man was sitting in the window seat and he asked if I would like him to put the screen up so I could see the clouds. With enthusiasm I said yes. We even exchanged seats and as I watched those clouds pass by I was filled with bliss. Truthfully, I was still flying when the plane landed. Yes, doing challenging things can be difficult, but the feeling it leaves you with is spectacular. The next few weeks facing challenging things were easier than ever. I was having a major growth spurt.

While working for that company, my mother was in a near fatal accident. Next thing I knew, I was experiencing a setback so severe I had to quit my job. For three straight months she lay in a hospital bed. I went daily to visit her with my aunt. Money started to run out so I needed to find work: any kind of work. I took a job washing cars. Once again I was letting anxiety dictate my work. The car wash was across the street from my apartment so that made it the perfect job at that time. As I began to climb out of the setback, I switched jobs again. The next one was as a waitress, but still it was walking distance from home. During this setback I could only drive when someone was with me.

I had met my husband while I was working for the financial services company. We weren't married then. We didn't even date. He knew I had anxiety disorder when I worked at that company. One day while I was at an outdoor mall, we ran into each other. We exchanged phone numbers and he asked me out. My first response was NO because I was afraid the anxiety disorder would get in the way of a possible relationship. How could I explain my current setback? I explained to him that I was even more anxious than when we first met. He said it would be OK, that we would just go to a movie. Well, I can still remember that first date. We both laugh about it now. In his car he had the newspaper with a few movies picked out. He asked what show I would like to see. The movies were only four miles away and a straight ride from my apartment. Months earlier this would have been easy for me to do, but not now. As we started to drive to the movies, I wanted to jump into the back seat. Not because I was feeling romantic, but because of my feeling of extreme anxiety. I pleaded with him to take me home... NOW. With a confused look on his face, he turned the car around. It is funny how once you start to head back home, you immediately calm down. Well, I must have sounded like someone who couldn't make a decision, because as we approached the apartment, I said we could still go out! There was a restaurant/bar near my apartment. I had never been there so I suggested we go. It was loud and crowded but still I felt safe because I was close to home. They had a live band that played terrible music at high decibels. We ordered some appetizers before the band started playing. Once the music started, we looked at each other and yelled, "Let's leave!" We compromised that date as well as the next few and chose places that were even closer to my home. In time I felt more confident traveling with him. Eventually we did make it to a movie. Within a few months of dating we were traveling to his family in New York City. That was a two-hour drive one way. Did I ever have anxiety attacks? YES. On those trips I would pack everything but the kitchen sink as a security kit. I would do crossword puzzles, word searches, and I'd write in my journal. At every rest area we pulled the car over. This way I could walk around and relieve some of the anxiety.

One of my favorite things to do was write to my cousin Barbara. I never traveled anywhere without my journal and one day instead of writing in it, I decided to write a letter to my cousin. Barbara, who lives in California, also had agoraphobia and was housebound. I met her for the first time a few years before. She never came out east to visit the family because of her agoraphobia. She told my mother and I about her condition, expecting us to be bewildered. Imagine how surprised she was to find out I also had agoraphobia. To this day she has those letters I wrote her on my NYC trips. We both laugh at those letters now because she could see from my handwriting how the attack was rising, peaking, and finally leveling off. “Barbara,” I write in my letter, "I just know I'm going to die this time." But, like every other attack it would peak and then cease. It really helps to talk to someone else who also has this disorder. Barbara has been a great source of hope and help for me over the years.

Why have I come to write the Anxiety Disorder WORKBOOK? After my mother was ill for more than two years, she passed away on April 1998. Then I had a miscarriage on April 1999. This was followed by thyroid cancer in August of 1999. Then the final setback came when we had a still birth November 5, 2000. My husband and I buried our little girl Yvonne Marie a few days later.

My husband's work moved us to NYC the following year. We moved in February and two weeks later he had to leave for job training for three months. It was time for me to have my cancer scans. As if that wasn't stressful enough--a new city, new doctors, and my husband away for months--I was still in setback. My father-in-law was wonderful about taking me to numerous doctor and hospital appointments. He sat for hours and never complained. However, I knew that I was in a severe setback again. I was facing that old anxiety and depression monster again. I started remembering how I first got back out of the house. A few times a week I forced myself to go to the grocery store alone for the exposure therapy. One day I went shopping and bought two plants for the new apartment. I named the plants Victory and Joy to reward my success. I talked to people online and found out there were so many similarities between people with phobias. Often what works for one helps another. My wish is that you too will find survival skills that will help you cope. My life is rewarding, now. I keep the anxiety monster at bay with all the coping skills I've learned along the way. So keep the faith and know that if I can do it, anyone can.

Introduction

If you are reading this workbook, it is probably because you are experiencing panic and/or anxiety. This workbook is filled with tips to help you gain coping skills to face that anxiety. It is recommended you do the relaxation exercises and keep a journal throughout the entire workbook lessons. Lessons 1 and 2 will teach you relaxation and journal writing. This workbook is put together in a specific order and we recommend you try to stick to the order we have designed. Some lessons you will want to spend a week or more on, and others you may want to spend less time on. We are all at various stages in our recovery and this workbook is meant to be referred to often.

Lesson 1

RELAXATION EXERCISES

What we want you to be aware of as you start these relaxation exercises is that your body has been in a state of tension for quite some time. Therefore, we need to retrain the muscles to learn to relax. Muscles have memory. Think of an athlete, who through practice and training, produces natural muscle memory from repeating the athletic movements. Examples of muscle memory are: speaking, walking, breathing, driving: the kinds of daily tasks we don't have to think about which muscles we are using when we do these tasks. For example, pick up a pencil. Do you need to think about this action? Most likely you are saying, “Of course not. It comes naturally.” But now remember when you were a child learning to write. You probably first learned how to hold a crayon, then use a pencil. And finally the day came when you were allowed to use a pen. Think of these exercises in the same way; as if you are a child learning to relax for the first time. Right now you may be tapping your foot, clenching your teeth or doing a number of other things that you have repeated since you became an anxious person. What we are going to do is retrain you to become a naturally relaxed person. It is most important to HAVE PATIENCE WITH YOURSELF as you practice and focus mainly on the progress. Imagine the rewards of how wonderful it will be to have a natural relaxation response built into your muscle memory. Enjoy the practice and do it as often as possible. We all know the importance of practice. Now focus on the rewards.

WE SUGGEST YOU DO THESE EXERCISES DAILY 2 TO 3 TIMES A DAY IF YOU CAN BECAUSE-

• IT WILL TEACH YOUR BODY A NATURAL RELAXATION RESPONSE AND-

• IT WILL REALLY HELP YOU DURING A PANIC ATTACK

1) START WITH DEEP BREATHS:

You will inhale through your nose and exhale through your mouth. Try to see your tummy rising as you breathe. If at first you feel dizzy or light headed, this is quite normal. We are not used to taking deep, relaxing, cleansing breaths.

COUNT UP TO 10 BREATHS

2) TENSE LEGS AND COUNT TO “3”. THEN RELEASE:

You will tense your legs. Hold to the count of three and then release.

You will repeat this step 3 times.

3) TENSE ARMS AND COUNT TO 3, THEN RELEASE:

When you tense your arms you can make a fist if you want to, but undo your fists on release. You will repeat this step 3 times.

4) TENSE STOMACH MUSCLES, COUNT TO 3 AND THEN RELEASE:

To tense your stomach, take a deep breath and pull stomach muscles in and then hold.

You will repeat this step 3 times.

5) TENSE YOUR SHOULDERS, COUNT TO 3 AND THEN RELEASE:

To tense your shoulders, arch your back so your chest sticks out. Generally you will find that there is a lot of tension in your back and shoulders. You will repeat this step 3 times.

6) TENSE YOUR HEAD AND COUNT TO 3 AND THEN RELEASE:

To tense your head you will try to touch your head to your chest. This too is generally an area of much tension so don't pull your head down to your chest. Just go as far as you can and hold, but you will feel tension as you do this step. You will repeat this step 3 times.

7) RAG DOLL:

To do the rag doll stand up slowly and then bend over at your waist and let your arms fall down to your toes. DO NOT TRY TO TOUCH YOUR TOES. You are relaxing your body so think rag doll instead of stretching. Then SLOWLY stand up.

IF YOU FEEL LIGHT HEADED IT IS OK. THIS IS JUST BECAUSE YOU ARE NOT USED TO RELAXING. IN TIME THE FEELING OF DIZZINESS OR LIGHT HEADEDNESS WILL GO AWAY. ALSO, IF YOU ARE DOING THESE

EXERCISES AT BEDTIME, SKIP THE RAG DOLL STEP.

IT IS BETTER TO STAY IN BED AND JUST RELAX. ALSO, YOU CAN DO VARIATIONS OF TENSING AND RELEASING MUSCLES WHILE IN THE CAR, AT YOUR DESK, IN A RESTAURANT, MOVIE, ETC. TRY DOING THE LEGS, ARMS, TUMMY AND HEAD. IF YOU CAN DO SHOULDERS, IT WILL REALLY HELP WHEN THAT ANXIETY STARTS TO RISE. YOU CAN PLAY AROUND WITH DIFFERENT MUSCLE GROUPS THAT CAN BE TENSED AND

RELEASED LIKE YOUR FEET AND ARMS FOR USE IN PUBLIC PLACES.

Relaxation Homework

1) Do these exercises 3 times a day.

2) Think of ways you can tense and release your muscles in the car, at your desk, the movies, etc. This way you will be prepared in public places to use this tool.

3) Keep track of your progress with the relaxation. Realize that in the beginning relaxation is new to your body and you need to practice that muscle memory. Be patient with yourself and accept that you are retraining your mind and your muscles. That is why keeping track of your relaxation progress will really help.

For example:

• Day one: unable to relax

• Day two: still a bit uncomfortable with relaxing

• Day three: relaxing more on about a scale of 2

• Day four: feeling more comfortable with the shoulder exercise

And so on. Just keep track until you start feeling that natural relaxation repose kick in, but don't stop the exercise; Continue to practice with the goal of creating relaxing muscle memory.

NOTES

Lesson 2

JOURNAL WRITING

Journal writing will make tremendous changes in your life. First, it will give you a place to vent your feelings. Second, it will let you see how far you have come. It is a record of your journey down the path of recovery. A journal is a place you can keep your private thoughts, become aware of your anxiety, and mark your progress. We will recommend ways to divide up your journal to give you the most benefit.

NEGATIVE THOUGHTS: Keep a log of your negative thoughts for a week. If you like, you can take a small note pad (or a PDA like a Palm or Pocket PC) with you all week long and then transpose them into your journal. In order to fix something you have to first be aware you are doing the behavior. By writing down negative thoughts as they come to you, you will now have the knowledge you need to start changing them.

REPLACING THOUGHTS: Now that you are aware of your negative thoughts, you can start to think of replacement thoughts. We are trying to reprogram ourselves to be more positive and active. Your negative thoughts will probably fall into one of three categories: 1. Things you can act on. 2. Things you cannot control. 3. Things that are just irrational--OCD (Obsessive Compulsive Disorder) thoughts--(those racy scary thoughts). For your journal you will want to place your negative or OCD/scary thoughts on one side and on the other side your new replacement thoughts.

We recommend you do this exercise often. In fact, do this every time you find yourself plagued by a thought that just won't go away or is keeping you from sleeping. Write the thoughts down so you can deal with them later when you are in a calmer frame of mind. If you have a therapist or close friend you may seek assistance with your replacement thoughts.

Ask yourself if you are thinking about a situation that needs attention. If there is anything you can do to take action on it, then make a plan to take action. This is a very effective tool for problem solving. Ask yourself if you are thinking on things that you have no control over and then just give it to a higher power and realize that is it OK not to have control over everything. Just imagine, if you had to control everything- the sun, the moon, the stars, the changing of the seasons, what an awesome task that would be. So, sometimes we just have to accept that there are situations and people we have no control over and have to just let it go. Ask yourself if your thoughts are seeming irrational. Sometimes you will see that in your anxious filled world you are thinking irrational thoughts that cause you anxiety. For example, I have personally had thoughts that people would just disappear while I was riding with them in the car. Fortunately, the thought has long since passed and it wasn't until years later that I realized there was a "rational" connection. (Refer to my opening remarks of my personal experience with anxiety.) My anxiety started when my father was dying of cancer and I used to take him for long drives. But my big fear was that he would die any second while we were in the car. Later I realized that my thoughts of people disappearing in the car was somehow related to this fear of him dying while we were in the car. So in a rational sense he would disappear. Sometimes you will not find a "rational" basis for your fearful thoughts, but the main point here is that the underlying fear was of something I had no control over- the fear of my father dying. We will discuss how to categorize your thoughts in the next two chapters.

In another section of your journal rate your anxiety attacks on a scale of 1 to 10, with 10 representing a full blown panic. When we rate them we begin to have awareness of the pre-anxiety attack symptoms.

Those symptoms might be: - Sweaty palms - Racing heart - Shortness of breath - Dizziness - Jelly legs - Nausea - Hot flashes

Once we become aware of our body symptoms and learn to rate the panic we will find that a level of 2 or 5 will not keep us from doing what we set out to do. In time you will find that even a level 10 can be handled, but when you see that you only had a level 5 when facing your fear and you know what it feels like to have a 10 you will gain more confidence and awareness. You will also learn what coping skills help you to keep your anxiety from getting to a level 10.

ACCOMPLISHMENTS: In this section you will write down all your accomplishments every time you attempt to face a fear. If you set out to go to the store and have to turn back for home when you are half way there, write it down as an accomplishment, because you always improve when you face the fear.

PROGRESS REPORTS: With the data you have collected on thoughts, and rating your panic and accomplishments, you can now look back and see your progress. This is so important to your recovery because we tend to be too critical of ourselves and fail to see how much we have progressed. Why? Because we want the total cure. Since we have made it to the store or have stayed home alone, this will show us how far we have come in our journey of recovery.

GOAL SETTING is very important. It motivates and pushes us to stretch ourselves. When setting your goals, think of the person you want to become, such as- I want to go back to work or I want to be able to drive alone again. I want to take a long vacation to a far away spot. Also set some goals you see as manageable, too. Such as- I want to go to the grocery store, or if totally housebound I want to get out to the mailbox. But let yourself dream when goal setting. Imagine yourself without anxiety and set goals. You will look at this page every week or month to see how you are progressing towards achieving your goals. You may want to update and change your goals from time to time, too, because often we underestimate ourselves when goal setting. Remember, shoot high; it will stretch you.

REWARDS, (what's in it for me), are great motivators. We cannot stress enough the importance of rewards. The rewards do not have to be elaborate or expensive. You can spend as little as a dollar on yourself to make yourself feel worthy of your accomplishments. You may choose to use award stickers for a job well done, or you might want to begin collecting inexpensive trinkets to track your progress. Of course, there is that wonderful thing known as delayed gratification where you can focus on a major reward like a new sweater, some CD's, or maybe some hot, new electronic equipment -- something you really want-- and reward yourself with it for continued progress. In the beginning, little rewards will give you the instant gratification you need. It can be a candle, nail polish, a magazine or time alone in a hot bath. Watching your favorite TV show. taking a walk, playing a game, or reading a book. Make your list of rewards but allow yourself to dream of a big reward for all your progress. Think how nice it is when people at work get a bonus check for a job well done. Well, this is work and you need to reward yourself! So get creative and use rewards as a motivating factor.

You will find your journal to be an increasingly valuable tool as time goes by. It will become your personal log of progress and when you have a set-back or a day you feel you are getting nowhere, you will have it in writing that you have improved. Also, the journal will give you the confidence to face a situation again. You now have it in writing that you did it before, so you can say, well I know I can do this because I have been here before.

WELCOME TO YOUR NEW LIFE! YES, THERE IS LIFE AFTER ANXIETY, AND IT IS MORE REWARDING THAN YOU CAN IMAGINE!

Journal Writing Homework

To begin, set your Journal up into 6 sections as follows:

1) Negative thoughts on one side, Replacement or positive thoughts on the other.

2) Rating your panic attacks.

3) Progress Reports.

4) Rewards.

5) Letters to your anxiety.

6) Notes.

Now begin by carrying around a small note pad or PDA to keep track of all your negative thoughts that you will later put in your journal. You may find that you have a lot of negative thoughts so you may only chose to write in your journal those that you obsess over. Remember, the reason for writing down the negative thoughts for a day is to heighten the awareness so we can begin to change the behavior.

Rate your panic attacks on a scale of 1 to 10. This will really help you see improvement. Write down the activity you were doing when you had the panic attack and what you did to make it a level 2 or 10.

Progress reports: This is a time when you go back and look at activities you are now doing more comfortably. You can write down those activities you would like to do the most such as:

Driving alone Going back to work Being home alone Speaking in front of people Standing in line Going grocery shopping

Think of the things you want to work on and rate your anxiety level at this moment. Then go back and re-rate your anxiety level doing these activities.

Rewards: Make a plan for your rewards. This is your place to decide what reward you will give yourself. This section can be set up with stickers for doing an activity and perhaps an inexpensive reward. You may want to use this section to write down the situation you will be facing such as:

Going to the store. Going to a family function. Going to a movie.

Being home alone.

Think of what reward you will give yourself for doing each as they come up.

Daily exposure tasks such as picking your children up at school may be rewarded with stickers. Doing a more stress producing situation like going to a family event or giving a speech at work may deserve more of a reward. Have fun with this section but remember to reward and praise yourself.

Letters to your anxiety are wonderful. You can write to it when having an attack. For me, I write to my anxiety like it is a person. I even give this "person" a name. You can try whatever works for you. Pretend you are writing a friend a letter. Tell them what you are doing to keep the anxiety from rising. Explain what you are feeling at the time of the panic. When you make it a person and not an "anxiety", it really helps because you may one day find yourself laughing at your symptoms as you imagine your "friend" receiving the letter.

NOTES is just a section for you to keep things about anxiety you don't want to forget. You may use it to write positive statements or things you have heard that really help you. This is your section for helpful websites you may want to revisit, books you may want, quotes, etc.

Notes

Lesson 3

Replacement Thoughts

We are going to work on replacing negative thoughts and those “Oh no this one is really going to make me go insane!” type of thoughts. If we have a thought that just ruminates in our minds, we are having OCD thoughts. The first thing to remember is that it's just a thought and many people have these scary thoughts. We don't act on them; they are just thoughts. We find them unbearable and incomprehensible; they scare us so much that we tend to obsess about them.

Now, like a tape recording in our head, we will learn how to erase this way of thinking and redo the tape we play in our head. We are going to work on making a new positive and rational recording in your head. Realize that you will have some erasing to do, but with time, practice, and repetition you will have peaceful replacement thoughts instead of scary ones. Try to remember a time before you had scary thoughts. Did you ever think something you were ashamed of, like I wish I hadn't (fill in the blank)
_________________
. The major difference is you had the thought and you let it go instead of obsessing. Thoughts pop in and out of our heads constantly, but it is the obsessing that paralyzes us with fear. That said, let's start learning how to reprogram our thoughts in a more productive and positive way. Now please don't start obsessing that you have caused yourself to have anxiety with your thoughts. Let's just focus on making it all better from this point on because now you know you can fix it.

So how do we start replacement thoughts? One great way is to keep a notebook with you all day long and when the thoughts come, write them down. You will address them later in the day. When you are not in a state of complete panic, look at your thoughts and start thinking how you can now rationalize them and make them more positive. Take those scary thoughts you have written down and think about what would be a suitable replacement thought. If you are having scary thoughts about medical issues, go to the doctor and get a check up. Taking action will give you a sense of control once a doctor has reassured you that there is medically nothing wrong. For example, you may think you have a heart condition or a brain tumor. If that is your scary thought, have the doctor help you with suggestions on how to stop worrying about these conditions so you can go on living each day to the fullest. Often people fear death. That is a common fear. But we have to realize that some things we have no control over. It will just happen. So do we really want to obsess over it and have it rob us of life today? Always ask yourself, "Is this serving me in a positive way? If not, let's rid ourselves of it."

For example, the thought that [I will go insane], (one of my personal favorites), can be replaced with [no one goes crazy from panic disorder], and if I was really going to go crazy it would have happened already.

You can use positive replacement thoughts with OCD, too.

When you just have the urge to do the dishes or wash your hands, tell yourself, I will not die if I wait
_______
more minutes to do that activity. It will be fine. Yes, I may feel a bit uncomfortable, but that is just a feeling and it will pass.

You need to make these replacement thoughts believable to you. We know from experience that we will live and survive the panic feeling. We have already survived it many times. Keep reminding yourself that you have had these scary thoughts and feelings before and lived through them. You can do it again.

As a matter of fact, we have been there many times. That is why we are reading this- to change it and make it go away.

One definition of insanity is doing the same thing over and over and expecting a different result, so we will now ask you to try something different. Talk to yourself; reassure yourself that you will survive; tell yourself you have nothing to lose and everything to gain.

So write down your replacement thoughts when you feel you can think rationally. And try to memorize them.

Also, you can memorize certain expressions such as:

IT'S NO BIG DEAL. IT WILL GO AWAY. I HAVE FELT THIS WAY BEFORE. NOTHING BAD WILL HAPPEN.

Try these suggestions or think of some of your own to use when you can't think of constructive replacement thoughts. It will really help.

PRACTICE, PATIENCE, AND SELF-PRAISE WILL HAVE YOU DOING AND FACING THE FEAR BETTER AND DIFFERENTLY.

REMEMBER, WE FUEL THE FEAR WITH OUR NEGATIVE THOUGHTS, SO LETS CHANGE IT AND START PUTTING SOME "WATER" OR REPLACEMENT THOUGHTS ON THAT FIRE.

Replacement Thought Homework

The best way to start addressing replacement thoughts is to realize the thoughts that need replacing. You may have obsessive or scary thoughts that bombard you, but throughout the day we have tons of negative thoughts. So for one entire day carry a note pad around with you and write down your negative thoughts.

Next, take the thoughts that bother you the most and write them down in your journal. When you are able, go back to these thoughts you wrote down and think about how to replace them with something more positive. Make them believable to you. As time goes by you will see that your replacement thoughts can be replaced with more positive ones.

Lastly, notice the positive changes in your thoughts and how much you grow. We welcome you to a new, better and more positive life. SO START

REPROGRAMMING YOUR COMPUTER IN YOUR HEAD.

Commit these replacement thoughts to memory and recite them when you have the negative thoughts.

Notes

Lesson 4

Scary OCD Thoughts

Why do we get those nasty thoughts we obsess over- (OCD, Obsessive

Compulsive Disorder thoughts)? One theory is we get these thoughts because it is a way of not dealing with what is really bothering us.

I will often ask myself when getting scary thoughts, WHAT IS REALLY BOTHERING ME? Sometimes the answer is THE SCARY THOUGHTS. Nonetheless, it is a good question to ask because other times I find that there is something extra stressful happening in my life. Perhaps a loved one is ill, or there are other major changes happening. Even positive changes can create anxiety. For example, moving to a newer, better home can be a stress because it is a stimulant to our system and therefore mimics panic. So being aware if there is some situation or change, maybe even a confrontation with a family member or coworker, can cause us to have scary thoughts. The frightening thoughts will help us avoid thinking about what is really bothering us. Other times though we just have these scary thoughts and start obsessing and there seems to be no reason. Like that first panic attack, it comes out of the blue. It does not matter if you find a reason or not, but it is good to ask yourself that question because it can help to calm you down. When this happens, try to say to yourself, "Of course I have these thoughts. I am really anxious over
______________
."

Now, what can we do with those pesky scary thoughts? How do you rid yourself of them? Lets begin by saying that no one has had a scary thought that some other anxious sufferer hasn't already thought of. Even though you think your thoughts are the weirdest, the most insane, and the worst ever, let us reassure you when people start sharing thoughts they are always surprised to find out someone else has had them too.

Now what would you do with a scary thought such as--:

"I'll go insane. I know I will hurt someone or myself. I
___________
(fill in your own scary thought).

Well, first try to find comfort in the fact that just because the thought is scary, you will not necessarily act on it. Your conscience is letting you know you find it reprehensible and won't act on it.

For those all too familiar physical thoughts such as--I'm going to die I must be schizophrenic.

I'm know I have a brain tumor.

I
___________
(fill in your own upsetting thought).

--go to the doctor and get checked out for what medical ailment you fear you have. Have the doctor confirm that you are not ill. Once you have received the expert opinion from a doctor that your scary thoughts are most likely generated by obsessive compulsive behavior, you can start to use that information to change them. Tell yourself the doctor has checked you out thoroughly. You don't have the condition you fear. It is just anxiety and it will go away. Remember, you have now taken control over the situation. You have done all you can do by getting checked out physically. Now you have to address the thoughts.

This is where your journal is a real asset to you. You have been keeping track of your thoughts. Remember that we have to be aware of a behavior that needs changing before we can change it. So go back to your journal, read your scary/OCD thoughts and write positive replacement thoughts. See which category they fit into: Irrational thoughts, things you can do something about, or things you must give over to a higher power.

Remember, we are reprogramming our mind. Practice, repetition, and replacement thoughts will send your scary/OCD thoughts into the recycle bin where they belong so you can delete them. Before you say to yourself, this won't work, remember this- YOU HAVE SCARY/OCD THOUGHTS BECAUSE YOU PLAY THEM OVER AND OVER IN YOUR HEAD. LET'S INSTEAD USE REPETITION FOR THE GOOD. LETS BEGIN THINKING POSITIVELY INSTEAD.

Remember, no one dies from a panic attack and if there really is something physically wrong your doctor can test you and treat you for it.

Scary thoughts are part of anxiety, but they are just thoughts and they won't hurt you.

What other ways might we handle these scary thoughts?

1) Write them down.

2) See if they're really rational fears. If they are, then ask yourself what you can do about this fear. For example, suppose I have a job interview. OK, most people are stressed out by job interviews. I will get my resume ready, plan what to wear, have my references ready and get a good night sleep. What if you have a fear that you will get an illness that runs in your family? Well, think about what you can do in that situation. Are there periodic tests you should get done? Then do it. But don't live every day fearing what may not happen anyway. So do what you can when it is a fear you can lessen, and then go on enjoying your daily life with the knowledge that you are taking action.

3) Try not to be concerned with fears we can do nothing about. For example, consider the fear of dying. Death is inevitable; it will happen to us all one day. So why worry about it? Do you really want to live each day in fear of something you cannot control? Accept it as a fact and say, "Why should I obsess over this? It is taking the present gift of life from me." This same approach works if you obsess about the death of a loved one. We need to realize we are robbing ourselves of precious memories of this loved one.

So in other words, PROTECT YOUR HEAD until you have mastered FEEDING IT GOOD, POSITIVE THOUGHTS. THINK OF YOUR MIND AS A COMPUTER: GARBAGE IN,GARBAGE OUT. DELETE THE GARBAGE AND INPUT GOOD FILES ONLY.

Scary OCD Thoughts Homework

By now you have these thoughts in your journal and probably have already started replacing them with more positive ones. If you have already done so or even if you are just starting to address these obsessive/scary thoughts, begin by putting them into 3 categories:

1) Thoughts that I can do something about i.e. see a doctor if you have obsessions about health issues. Really think if there is some action you can take to address these thoughts.

2) Some thoughts will just go into the irrational category. These thoughts will go away with time and practice. Use replacement thoughts and rational thinking. Memorize your rational replacement thoughts and say them when these thoughts pop into your head. Make a list of these thoughts and do the rationalizing.

3) Sometimes there are thoughts you just have no control over. It's best to give these thoughts up to a higher power. Just accept that we cannot control everything and be grateful for that fact. Think about things you have no control over like the sun rising in the morning. Imagine how overwhelming it would be if you really had to control everything in the entire universe. Just be thankful that there are others at work out there helping to make the "world go 'round." Give yourself the freedom that comes with letting go and accepting what comes. It is nice to know that you don't have to do or control everything. Practice feeling that peace and it will help you to see that even the things we wish we could control when we let them go will give us peace of mind.

So, finally, invent you own philosophy about life events and control issues; one that is believable to you and gives you peace. See these thoughts as an opportunity to examine your life and develop your philosophy to live by and then practice your personal philosophy.

Notes

Lesson 5

Distraction Tips

Distraction is a great way to decrease or put a stop to anxiety attacks. Why, you may ask? Well, it's very hard for our mind to entertain two thoughts at the same time, so distraction helps those scary thoughts pass quicker or at least more bearably. We are going to suggest some distractions for you, but through your own experimenting you may find things that work better for you.

For example, if you are home alone, or even with someone and that panic starts to rise, get physically busy. Rearrange drawers; clean out closets; vacuum the carpets. Physical activity really helps you with the fight or flight instinct that you are experiencing. In other words, it gives the adrenaline a place to go and gives your mind something to focus on. Perhaps you are physically tired. This is a great time to write in your journal, or do things that entertained you as a child such as coloring in a coloring book or maybe doing crossword puzzles or word searches. Who cares if these activities are not "productive". Remember, they really are productive because they are helping the panic, and that is very productive. You may want to learn a new craft like crocheting, wood-working, or painting. It is just for distraction. The final project doesn't matter. The end result is to learn to stop the panic, not necessarily to make something, although this would be a fine byproduct of your experience.

Through this process you may find that you will learn a new skill like calligraphy or something equally cool, but the real objective here is to lessen the panic. So remember that this is the primary objective. I can't stress enough the fact that your goal is to get rid of the anxiety, not produce something specific. All too often we are so hard on ourselves and feel we need to have something to show for our time. Look at it this way- if you have the panic attack, what have you really produced? What is there to show for your time? Frustration, fear, anger, fatigue. But if you color in a coloring book, you have taught yourself to relax, and what a major accomplishment this is.

Other distraction techniques: - Take a long warm hot bath - Watch TV.

- Read a book.

- Try to learn a new language.

- Try new hairstyles.

- Write a letter to someone, even yourself.

- Play with your pets.

- Light some candles and focus on the scent and the glow of the candle.

- Make something.

- Exercise.

- Practice your deep breathing. - Put together a puzzle. - Make a model airplane, ship or car.

It is best if we have tons of distraction techniques because anxiety causes our level of concentration to change so much. One day you may be able to work on a puzzle. Other times the pieces may look all fuzzy and just frustrate you more. So that is where coloring or something equally simple will be a more effective distraction. How many times have you tried to read, only to find that the words all run together? Other times you just can't seem to absorb anything. That is when you may want to practice a more mindless form of distraction.

With a long list of distraction tools and knowing your body and anxiety you will find which tool work best at different times. Remember, you are gaining from these activities; you are learning to ignore the anxiety and to relax. So create your own list of distractions and have fun.

Distraction Tips Homework

Take time to make a list of things you can do as a distraction when panic arises. It will be helpful to divide your list. Take your time and make a plan. For example, at a restaurant you can always balance your checkbook, rearrange things in you handbag or wallet, write in your journal, or make a list of things to do the following day. Get very creative and as you find new things to do, write them down and you will find your list growing. Don't make these activities complicated. An activity as simple as people watching can be a fun activity.

- Things to do when at home:

- Things to do when in the car as the passenger: - Things to do when in the car as the driver: - Things to do when in school or at work: - Things to do at a restaurant or public place:

- Things to do when waiting in lines at grocery store, bank etc.

Having a plan will help you feel in control. Have fun with your list of things to do.

Notes

Lesson 6

Being Alone

There are many theories about the fear of being alone. Some people are frightened with too much time to think. For others, they fear that separation can contribute to anxiety. However, whatever the reason for our anxiety, let's discuss some practical reasons for the fear and face it.

If you have a fear of being home alone, try some exposure therapy. Have a person you trust leave you alone for a certain period of time, maybe 5 minutes, and then have them return. During this time make a list of things you can do to distract yourself. You might even want to cover the clocks if you find yourself watching them too much. Pretend that someone is there by playing music in your child's room so that the silence doesn't make you start thinking WHAT

IF
__________________
.

Think about the things around you--the sights, scents, sounds--and touch the things around you. Maybe light a candle, play some relaxing music, pet your animals, etc.

Make a safety kit for yourself. For example, have the phone number of people you trust on speed dial. Then make a list of things to do to distract yourself. In time you won't need your safety kit because you will realize that YOU ARE YOUR OWN SAFE PERSON, but for now it will help you.

A safety kit or a plan gives us the sense that we have an out. It is kind of like a fire exit. We most likely won't need it, but it's good to know it is there. Also, preplanning gives you a sense of control and control is a major issue for most of us. So give yourself a plan with plenty of outs. They will really help you lower your anxiety level.

Suppose one of your fears is being alone in public places. You can still use the same techniques. Start with the exposure therapy. Go to the store or bank or grocery with a "safe person" and have them wait outside for you at first. Or plan to meet them in a certain spot at a designated time.

YOU WILL REALIZE THAT 5 HOURS WILL BECOME AS EASY AS 5 MINUTES IF YOU PRACTICE DILLIGENTLY.

Remember to reward yourself as you improve. REWARDING YOURSELF gives you a POSITIVE ASSOCIATION WITH THE PANIC AND ANXIETY. POSITIVE REINFORCEMENT works wonders. Think about training a pet. You reward it for good behavior. If you ever tried to housebreak a puppy you know that you applaud and praise your pet. Positive reinforcement works for people, too. Think how you use it with your children when they behave well or receive good grades. Why do we forget to reward ourselves? Everyone deserves a reward--especially us--because we are facing our fears daily and at this point it may seem like you are facing them 24/7. But with practice, your coping skills will greatly improve. Above all else, don't lose hope. You will only be defeated if you allow yourself to.

Now you will have a good association with being alone instead of a negative one. PRAISE AND REWARDS ARE IMPORTANT. We are reprogramming our minds to think differently about the anxiety. So reward yourself.

Being Alone Homework

There is no time like the present to start facing the challenge of being alone. Remember- baby steps. If being alone at home is a challenge for you, ask someone to leave at a certain time and come back in five minutes.

If you fear being alone in a store ask someone to leave you alone in the store for 5 minutes and then meet you at a certain place in the store.

Think about which situation you want to handle and make a schedule for practice.

If being alone anywhere is a challenge for you, start with home at first and make plans to build up to other places later.

Make sure you have your plan for what you will do during the time you are alone.

Mentally prepare yourself; you can do it.

Think about how you will reward yourself for being alone. We cannot stress the importance of rewards enough. You are reprogramming your head. Make it a positive association.

Last, celebrate your accomplishment with the person who is meeting you. High five each other, boast, brag, and scream I DID IT.

Notes

Lesson 7

Safety Kits

Safety kits can really help you, especially when you start to travel. What is a safety kit, you may ask? Well, it is a collection of things that help to bring your anxiety level down, and you take them with you just in case you need them.

In time, you will learn to cut down on the size of your safety kit. At first, I felt like I traveled with everything but my kitchen sink, but if it got me there, so what? The kit fulfilled its purpose: it got me there without me slipping into a full-blown panic along the way. One thing that is extremely helpful in a safety kit is very cold water. If you know you have a trip you may want to freeze a bottle of water to take with you so it stays cold the entire trip. Sipping cold water will help you on the road and at home too. Focus on how good the cold water feels going down and how it is refreshing your body.

Now let's consider some other things we might put in your safety kit. Do crossword or word search books occupy your thoughts? If so, add them to your kit. You can buy them in paperback in the grocery story by the checkout counter. This is a handy size to carry with you. Perhaps having pictures of loved ones or a photo of your home makes you feel better. If so, take them with you. I have a briefcase to carry with me if I need to carry a few different items in my safety kit for a particular event. Once again, don't worry about what people think. The purpose is to help you reach your goal of getting to your destination. If it is legal and it helps, why not? Focus on your goal of getting there: the safety kit is just a tool. Just think of the joy you will feel when you can go out again and then the joy you will feel when you are able to leave something out of your safety kit when you travel. Some may say that a safety kit is a crutch. Well, maybe it is, but if it gets you out there doing things, it will have more than served its purpose.

Scented things can also be wonderful in a safety kit. Aroma really helps to alleviate anxiety. It changes our focus. I can remember in an auditorium sniffing a handkerchief with lavender on it to calm me down and keep me in my seat. You can easily purchase a scent you like in oils or perfumes or sachets, and focusing on the scent will help to take your mind off the anxiety.

I remember a time when I had to be in the hospital for three days. I brought a rose in the room with me and smelled it over and over when anxiety started arising. I was having radiation treatment and was not allowed visitors, so that rose was so comforting to hold and smell. In time you will find things that work for you. Think in terms of your senses.

Ideas:

> Something for your eyes to focus on, like a picture or word search book.

• Something for your nose, such as a scented handkerchief.

• Something to touch. Maybe beads or a stuffed animal. If you have a personal faith, you might want to carry the beads of your faith with you.

• Something you can listen to. Perhaps a favorite tape or CD of music.

• I personally love a GameBoy or cell phone to play with because it covers touch,

sight, and sound. If you own a Palm or Pocket PC, load it with ebooks and games.

Try to think of what you like and don't worry what others might think. The goal is to GET BACK OUT THERE AND LIVE AGAIN.

You also can devise a safety kit for being home alone. Many of the suggestions above will work, plus you can think of your own. Having a list of things to do really helps if panic arises and you are home alone. You won't have to think about what you can do to stop your panic. You can just look at your list of things to do and pick one. Think of BEING ABLE TO MAKE CHOICES BECAUSE IT IS WHAT YOU WANT TO DO AND NOT BECAUSE THE ANXIETY IS MAKING YOU DO IT. CONGRATULATE YOURSELF FOR MAKING TERRIFIC PROGRESS AND KEEP UP THE GREAT WORK.

Safety Kits Homework

Make your own safety kit or kits. Depending upon when and where you tend to have panic attacks you may want different kits. Think about the distractions and what will work comfortably for you. By now you should have some idea of some distractions that work for you. In time your goal will be to eliminate your safety kits and learn that you are your own safe person.

Some ideas for kits.

1) Safety kit for being home alone. 2) Safety kit for driving with someone. 3) Safety kit for driving alone.

4) Safety kit for going to public places.

5) Safety kit for extra long trips.

6) Safety kit for staying overnight away from home.

Remember that in time you will find that in various situations you will learn to use one or two items in your safety kits more than others. Eventually you will be able to slowly get rid of items in your kits. Your goal now is to go out and face the situations with more comfort. In time you can work on letting go of your safety kits altogether.

Notes

Lesson 8

Driving Tips

For many of us, driving is quite a challenge. We are going to give suggestions for driving or riding in the car. These steps are going to start as if you cannot get into a car at all and build you up step by step to get you out on the road again. Some of you may be further along with your driving and that is wonderful, but to reach everyone we will start from the beginning as if you have not been in a car or have extreme panic in the car.

Begin by just thinking about driving. Does that cause some panic? OK, use your skills and rate your panic. Is it a level 10 or is it less? If the thought of driving has you at a level 10, use your positive self-talk and relaxation to lower that to about a level 2 or 3. At some point you will just go out to your car and sit there inside it, feeling the panic rise and working on lowering it. Step by step you will work your way down the panic scale and closer to driving by yourself or with someone. We know the challenge of exposure therapy, i.e. going into the phobic situation. But think about your rewards. Baby steps are major steps when doing exposure therapy. So praise and reward yourself for every attempt you do to go out into your phobic situation. With practice, self-talk, praise, and rating the anxiety you will be on the road once more.

Some ideas of how to take baby steps- First start your car and slowly back down the driveway. Maybe you are still at the stage where just opening the car door is a challenge. That's fine. Go from whatever point you are at and know that you will only improve. When I personally started doing this my first thought was what would the neighbors think of me doing this: sitting in my car and going nowhere, or just backing down my driveway? Well, I never learned what the neighbors thought. I decided to make a commitment to me and my recovery. Who cares what the neighbors might think? It was not as important as getting well. Getting well has to be your top priority. Remember that your neighbor would most likely understand if they had the terror you had in the car and would respect and applaud your actions to get better. Remember that you are taking control of your anxiety; you are taking action and action leads to productive activity, so who cares what anyone thinks?

You will find yourself so full of joy as you get better and better and make that first trip around the block. Taking baby steps are actually giant steps. The idea is to expose yourself to the phobic situation in stages using all the skills you have learned.

Let us discuss some longer trips. One good thing to do is prepare. Give yourself plenty of time to figure out the route you will take. If highways are a challenge for you, prepare for this. Perhaps you can use some back roads. A different route may take longer to get where you want to go, but it will also probably be more comfortable for you. Many people feel more comfortable if they know where all the hospitals are when they start to travel. You will find that you probably won't go to one but it just gives you a sense of security. In time you will just feel secure with yourself and not need these crutches, so be patient with yourself.

Often you will hear someone say they have to travel past their safety zone. OK you can do it. How long is the trip you have to make? An hour perhaps? I remember my first hour trip. My safety zone was fifteen minutes. At that time the way I prepared my mind (because, remember, it is the way we think that fuels the panic) is I went out driving for an hour in my safe zone the night before. I just drove round and round. I kept telling myself I could handle being in a car for an hour. I broke it down into four 15 minute increments. On the drive I kept telling myself, "OK you have driven 15 minutes. Now you are just going to do that four times." Did some panic creep in? Yes, but not at a level 10. We pulled over if needed. We used positive self-talk. We looked at the map. We stopped to do things. We had a tape in the cassette player that made me feel comfortable.

There are so many things you can do to make the trip easier. Focus on trying to count all the red cars. Do math problems in your head. Find a tape you love to listen to and repeatedly listen to that tape in the car because you will have a sense of control as you hear the songs play over and over. Do you recall the story I told you about playing the same tape over and over on the way to work? Work was 15 minutes from home and I had to drive 5 days a week by myself. I would play that same tape every morning and evening traveling to and from work. I would sing the songs and gauge my distance by the songs playing. That way I could reassure myself, “Just two more songs and I'm there.”

Some people love to take a picture of their house with them. You can put it on your dash board or visor. Perhaps a picture of a loved one will comfort you. Cell phones are wonderful. They make you feel you have constant contact with others. Have phone numbers programmed into your cell phone. You may need help and all you have to do is call and say hi. That alone will be comforting.

If you are traveling with someone, explain to them what will help you calm down as you travel. For me, if my husband fibs and says we are almost there in an effort to make me feel better, it actually does make me feel better! Sometimes I ask him to lie to me and say we are almost there when panic arises. Find out what works for you and you will be surprised how much the person you are traveling with will want to help you. Often they just don't know what to say so they often say the wrong thing: not intentionally, but because they have not been told by you what you need. You will benefit most if you tell the person you are traveling with before the road trip what will help you when panic arises. It is much better to work this out beforehand instead of when you are already on the road and the person you are with is trying to help you and drive at the same time! By taking small trips you will learn what you need from your support person and be able to coach them.

Nothing is more fun than having the freedom to travel, so the rewards definitely outweigh the anxiety. Remember, think of the benefits you will gain and enjoy the road.

Driving Tips Homework

We are going to give you some clear assignments for driving again. We know that many of you are at different places in your driving abilities so begin at whatever stage you are and realize you will and are getting better.

If you haven't driven in a while, start by making goals to go out to the car. Let the panic start to rise and stay, even if you don't get into the car. The main thing is to face the fear. That is when the healing really begins. Let your panic come and rate it. Don't give in to the "fight or flight" feeling you are having. Each time you expose yourself to the panic you are getting better and better. See it all as progress. If you have driven, the same techniques will apply, even if you are riding with someone.

1) Expose yourself to the phobic situation.

2) Feel the anxiety level rise and let it come.

3) Address the urge to "fight or flee" by staying for even a second and letting the anxiety come. If you are at the car door, stay there and feel it rise. If you are riding in the car, pull over but wait and let the anxiety come before you turn home. If you can continue, do so. That is what the goal is behind letting the anxiety level rise- to see that it will come and leave. Once it's gone, you will be able to go on with your planned task. Don't get discouraged. If you do, turn around and go home. Every time you face the fear, you are improving.

4) Start to set weekly or daily goals and keep track of your progress. Remember, we sometimes take four steps forward and two steps back. See it all as good. There may be days you can travel further than others. It's OK. The constant exposure will improve you. Think of yourself as an athlete in training and realize that not every day will be a peak performance day. But every day you practice is a day you have worked towards your goal, so it is all good.

5) Praise, praise, praise yourself. You are facing your fear and doing it. Think about how you will reward yourself. Jump, scream and shout. I did it, you can too. Make that new positive association. Hug yourself and say I, AM doing it!

Notes

Lesson 9

VOCABULARY CHANGES

Remember, your mind is like a computer. Garbage in, garbage out. You will be amazed what a change in your vocabulary will do for you. We can't stress enough the importance of monitoring your thoughts, and vocabulary is a big part of how we think. For example, the word “problem” does not trigger the same anxiety response that using the word “challenge” does to describe a situation.

When you are working on vocabulary changes, also consider your tonality and body language. To demonstrate what we mean, imagine someone calling you an idiot. Can you feel your blood pressure rising and your temper wanting to flare? Or do you feel dejected and inferior. Now imagine that the person calling you an idiot is wearing a clown suit! He has on big baggy pants, oversized red shoes, a red clown nose and hair. He leans towards you with his white painted face and bright red nose and says you are an idiot, stretching the word "idiot" out long and slow with a rise in his tonality, especially on the last syllable. Are you upset and insulted? Probably not. Most likely you are laughing with the rest of the audience. (Social phobia aside)

Vocabulary and the way we say it means so much, and considering the fact that we have this little voice inside that talks to us all day, we can improve our lives by being more aware of what we tell ourselves and how we do it. All too often you will hear people say that when someone asks them how they feel they just expect the traditional response of, "Fine, and you?" Well, why don't you try changing your answer for a day. Tell everyone you are fantastic. Say it with enthusiasm and conviction. See the reaction you get and see how just changing that one aspect of your life makes you feel. In time you will be sending a message to yourself that you are doing fantastic or wonderful or whatever word you choose. What have you got to loose? You probably have been saying "fine" or something else equally lukewarm and meaningless so why not try saying something positive and meaningful?

Little changes in what you say and how you say it can really make a difference in your anxiety. Remember the lessons on scary thoughts and replacement thoughts? Well the things we say are first a thought. When we suggest that you say you are feeling wonderful, that is not to say that you have to lie and hold back your anxiety and depression But we all know that we show one face to the world and another to our closest friends and family members. It is important to be honest with your emotions and feelings but at times you will find that trying vocabulary changes and a smile even when you don't feel like it will actually help elevate your mood.

Imagine for a second having an anxiety attack and all of a sudden seeing a circus elephant walk down the road. It probably would stop that attack and make you laugh. Why would this response happen? Because the surprise would probably tickle your funny bone. Now imagine yourself having a panic attack and then seeing fire engines and hearing the loud siren. You can feel the level of anxiety rising high because we associate that sound with anxiety. Even a door slamming can make you jump when you are in panic. That is why we suggest that you alter your vocabulary. Think of things that have a more positive association.

For example what feelings do these words bring to mind?

• war - conflict - struggle

• problem - challenge - situation - opportunity

• anger - frustration

• sorrow - sadness - a bit low but improving

• abused - victim - survivor

• lonely - alone - networking

• trying - doing

• stupid- learning-growing

See how some of these negative words are more positive when you change them, but also notice the feeling when you change these words. For example, consider the word PROBLEM. It makes you feel a bit overwhelmed. But a challenge is manageable. Can you visualize the day that a PROBLEM BECOMES AN OPPORTUNITY? You know for some people that is just what a PROBLEM is. An OPPORTUNITY. One of the most valuable people in a company or your home is the one who is the PROBLEM SOLVER. At some jobs if you don't have problems to solve there is really no reason for you to be there, so what an opportunity that is for the person in that position. Try to think of times your problem solving skills are an asset.

We want you to do a little exercise. Place a pencil on the floor and try to pick it up. What happens? Can you do it? No, you probably can't if you think you can't. All you can do is try to pick it up. Do you see the difference and how negative thoughts can affect us? So next time you are faced with a problem, tell yourself I CAN, I WILL, I AM and we know YOU CAN, YOU WILL, AND YOU ARE

CHANGING YOUR VOCABULARY AND YOUR LIFE IN POSITIVE WAYS.

Vocabulary Changes Homework

Spend the day thinking about how you can change your vocabulary for the better. Words makes us feel certain ways. Think how you feel when you hear hate versus love. So for your homework do the following:

1) Start with an awareness of your vocabulary. See if there is a negative word you constantly repeat throughout the day.

2) Begin by changing this word, problem; maybe it is problem, but it could be softened in your mind by thinking of it as a situation instead.

3) Start to think of other words you can change in your vocabulary and see how they create a different body response. Remember the feeling the word hate gives you versus the word love. Get to know your own body responses to words and consciously use words that produce a positive feeling.

4) Notice the reaction you have to words others use around you too. See if you can repeat their negative statements in a more positive way. For example, if you have someone who constantly puts you down, think how you can change it. For example, suppose you really screwed up. Say to them, "Yes I did make a faux pas. I am growing and improving." Just think how the word faux pas will make the person telling you how much you screwed up react. It is kind of funny to think about that response. You cannot think about their growth- only your own. Is this being selfish and unfeeling towards others? Not at all. You can't be a good friend unless you help yourself first.

5) When asked how you are feeling today, respond positively instead of delivering a mindless, "Just fine, and you?" You will be surprised at the reaction you will get if you tell someone you feel wonderful. Remember that in time you will start to believe that you really do feel wonderful, and with that healthy attitude you will make those around you feel better as well. You will become a magnet that will attract positive people and feelings to you.

Notes

Lesson 10

DOING IT ANYWAY

Doing it anyway: what a concept. Right now you may be housebound, or maybe you just panic when you're in a tight situation, like maybe standing in line in a public place. But wherever you are we want you to know that doing it anyway in spite of the fear works. Think back to a baby learning how to walk. We think it is so cute to see them fall down on their diaper-padded bottom. They take a step or two and fall down. They may even flash a charming smile and giggle cutely when they do. And what do we do when our precious babies make their first attempt? We encourage them to keep doing it anyway. And once again, what a concept! Just think if the first time they tried to walk and fell down we said, "On no! Don't get up! Don't walk! You may fall down again and hurt yourself!" Would you be walking if you parents did that to you? Of course not. That's why we have to get up and try again. You have to find the strength to temporarily push your panic aside and try, try, try again. So what if you start to go to the store and don't get there. Remember the baby that tries to walk across the room and falls down after a step or two. Remember how we praise that child and encourage it to keep trying.

Fall down and get back up. Praise yourself for taking one step. Every attempt you make gets you closer to your goal. And guess what? It works! We learn to walk that way. Now it's time to act that way.

OK, now think of an athlete in training. They train and train. Training becomes their life. They develop calluses, get broken bones maybe, have aches and pains, but they do it anyway. Sometimes they fall in a sports arena full of people, but they do it anyway. Why? What drives them? What drives the baby to continue to learn to walk? DESIRE. Tap into your desire to get better. To get your life back again. Desire is a strong motivator. It will make you do it anyway. REMEMBER, YOUR DESIRE TO GET BETTER IS STRONGER THAN YOUR FEAR. Even though you may get a bit bumped and bruised along the way, the rewards outweigh the challenges.

Become your own coach. Set goals for yourself. Would you respect a professional athlete who just didn't feel like playing the day you paid to see him (or her)? No, you wouldn't. You would expect them to play anyway. You would want their coach to ream them out or penalize them in some way. Perhaps you would want that coach to motivate them to get out there and do it anyway, that no matter what, it will be OK. Maybe they will have a terrible game but at least they played. We will never know what we can fully accomplish without doing it. Try to at least be in the game before you decide to pull yourself out of the game. It is OK to go back home due to anxiety, but you should at least try to face it. Be your own cheerleader. Imagine you are that same athlete having a great game where the crowd goes wild. And even if the athlete gets injured on the field, the crowd applauds them for doing it anyway. We need to applaud ourselves every time we face the fear, every time we do it anyway. Whether we have a perfect game or get injured, we need to be a cheerleader, simply because we did it anyway.

Now let's relate this concept of doing it anyway to the work place. One of the first things involved in success in school or work is showing up. Just by showing up you get some benefit. When we show up and face that fear we have already accomplished something. Maybe you don't accomplish all you want to at work or school, but by just showing up you are at least on the right track. Why do they give rewards for attendance? Because nothing can happen when we don't show up. But by showing up there are limitless possibilities. Attendance is not a form of punishment. We put an emphasis on it because it opens up opportunities. Even on a not so good day you will get more done if you are there then if you never showed up. Keeping that in mind, when approaching your panic situation think of the following:

• Show up.

• Don't give up.

• You made the effort to show so do something anyway.

• Praise yourself for showing up.

• See it all as progress. Whether you get anxiety and have to turn around or not,

or you successfully complete the task. do it anyway and see it all as progress.

Doing it Anyway Homework

Doing it anyway means just sticking to your commitment no matter how lousy you might feel. The homework for this is as follows:

1) When you have something scheduled to do and that panic feeling hits, do it anyway. Even if you have to turn around and go home it doesn't matter. Remember that showing up is key if you want to get better.

2) Really praise yourself for doing it anyway. These are the days that your DESIRE TO GET BETTER IS WINNING OVER YOUR ANXIETY. Praise yourself just for showing up i.e. going to the grocery store even if you have to leave because you are really progressing when you do it in spite of how you feel. Anxiety is a feeling and every time you do it anyway you are saying ANXIETY, I WON'T LET YOU DICTATE MY DAY TO ME! I CONTROL MY DAY, NOT YOU!

3) Look for the good in what you have accomplished and keep track of your progress. For example, if you didn't feel like going to the grocery store but did it anyway, (even if you didn't make it all the way there), see how much easier it is on a day when the anxiety is not trying to tell you that you can't go today. EVERY TIME WE MAKE A DECISION AND STICK TO IT, NO MATTER HOW

UNCOMFORTABLE IT MAY MAKE US, WE ARE IMPROVING. PRAISE

YOURSELF AND KNOW THAT IT WILL BE EVEN EASIER TO DO YOUR TASK THE NEXT TIME.

4) Reward yourself in some way. always have that positive association. Visualize yourself as an athlete in training who just played a major game while severely injured because the DESIRE TO PLAY WAS MORE POWERFUL THAN THE INJURY. Be your own cheerleader, coach, and fans in the stadium and give yourself a CHEER.

Notes

Lesson 11

STOP, LOOK, and LISTEN

At this point we are going to try to deal with those wonderful panic attacks. As you are having a panic attack, remember that things are happening in your brain. It is wildly signaling "FIGHT OR FLIGHT". This response does have a purpose when we are in real danger. It helps our body produce adrenaline so that we have the energy and strength to fight the dangerous thing or flee it. Think of our ancestors who often ended up with a saber tooth tiger in their path. That anxiety was a good thing. But what we have now is this "fight or flight" response in a line of people at the grocery or bank, in the car going for a drive, when at home alone, and you can probably think of many other places you have them as well. Do we really need to flee or fight something? NO. That is why we are going to learn to stop, look and listen when panic starts to arise.

Imagine this scenario: You start to head out to the store and all of a sudden you find yourself with this overwhelming feeling that you MUST go home...NOW! OK, you have been here before. We are going to ask you to stop for a second and do the positive self-talk. Become aware of your surroundings, tell yourself it is OK. Say to yourself, “I will stay for a bit and not give in to this feeling that I have to flee.” Look at the things around you. Tell yourself you have started out for the store and you are part way there already. So, why go home? You've come this far. Why not finish what you've started? Listen to what you are saying to yourself that made you panic. Were you scaring yourself with the WHAT IF's such as, once I get to the store I just know I will pass out or make a fool out of myself? This is a great time to write all this down in your journal and remember what you did to trigger the panic and then write down how you are now using those replacement thoughts to stop it.

At the point of panic, STOP, LOOK, and LISTEN. When you make that fearful trip to the store and only make it part way, if you stop and carefully analyze your predicament, even if you turn around and go back home you've made progress. Praise yourself. EVERY TIME YOU STOP, LOOK, LISTEN YOU ARE

RECOVERING. So what if you did turn around and go home. Have you failed? No. At least you stopped for a second or two to think, and that is major progress. We start to change our behavior as we become aware of triggers and you now became aware of a trigger and can start to use replacement thoughts, distraction techniques, relaxation to enable yourself to go to the store in the future.

Once again think of yourself as an athlete in training. You don't start to make perfect shots in golf or basketball. No, we practice and practice and make adjustments. You will never start making adjustments until you have made that first shot. And then you need to keep making shots and making adjustments until the shot is refined. In time the athlete learns muscle memory and a better technique. That is what you are doing; learning muscle memory and technique.

Soon you will find you have instant muscle memory for a relaxation response and a refined technique and eventually you will be the calmest person in any situation, even a crisis.

THERE IS LIFE AFTER ANXIETY! IT IS RICHER, MORE FULFILLING, AND YOU WILL FIND THAT ONE DAY YOU WILL BE SO GRATEFUL THAT YOU HAVE HAD THIS CONDITION BECAUSE OF ALL YOU WILL HAVE GAINED FOR IT. SO KEEP THE FAITH AND SEE YOURSELF AS IN TRAINING, CONSTANTLY IMPROVING YOUR TECHNIQUE AND REACHING YOUR GOALS.

Stop, Look, and Listen Homework

There are two ways you will do your homework. One way will be to schedule time to use these skills. The other way will come about spontaneously when that panic happens out of the blue.

1) Think of situations that generally make you panic.

2) Deliberately put yourself into that situation. Perhaps it is standing in line at the bank or going to a large department store.

3) Feel the panic start to rise and then stop and look around you. Listen to the sounds. The purpose of this exercise is to put yourself in the context you are in at that time. Do not think ahead. Live in that moment with all the sights and sounds.

4) Start to find yourself enjoying the sights and sounds. Realize you are safe in that moment and there is nothing to fear except the feelings you have, and they will pass as you pay more attention to the things around you. For example, look at the other people in line or focus on the things in the store. Notice if there is music playing or people talking. Fix your focus on one particular thing at first. Then let your eyes see more.

5) Notice how focusing on the sights and sounds around you help the panic level drop, because your mind cannot focus on two things at once.

6) Praise yourself for taking the time to notice things most people don't even notice. YOU ARE LEARNING TO TAKE TIME TO "SMELL THE ROSES." CONGRATULATE YOURSELF ON YOUR PROGRESS.

Notes

Lesson 12

How to Manage Your day

How often do we feel overwhelmed by the things we need to do in a week a day or even a few hours? We will discuss some ways of managing our day to make it easier and also to get more done in less time. First of all, imagine yourself holding 20 pencils in your hands. Now picture yourself trying to break all of them at once. Come on, try harder. It seems impossible, doesn't it? That is all too often how we structure our days with 20 or more things on our mind at one time and trying to handle them all at once. Now picture yourself just holding one pencil. Once again try to break the pencil. *Snap!* You can hear it break. OK, you are saying to yourself, but how does that help me manage my day? I have 20 pencils in my hand at once most of the time. Well, we will break those tasks/pencils one at a time and here is a simple formula you can use to do just that.

First make a list and divide that list up into three categories:

1) Things that must be done at a specific time.

2) Most important things to do.

3) Things I would like to do.

Schedule in the things that must be done at a specific time such as a Dr. appointment, school, a meeting at work, etc. You know that these have to be done in a time frame, so plan your day. Do you need time to travel there and back? Figure out the time slot. This will mean putting scheduled things ahead of others. We usually don't want to change when we make a commitment and we should try to accomplish these things.

Next you will make a list of things that need to be done. Really think of the three most important things and write them down. When you do this, really think about what is the most important. Stay on that one thing until it is finished. If you only get it half way done and the day is now over, so what? Remember, you said it was the most important thing to do, so praise yourself for working on it. By making this list you will find that you will not waste time on trivial things like sharpening pencils because you will have focus now.

Lastly, things you want to do: Don't minimize this. You need to have some time for yourself too, but these are those things you want to do but don't have to be done. If you need ten minutes a day to meditate or relax, then stick that on your most important things list. This is a list of things you would like to do if you have the extra time. Maybe you want to paint a room or visit a friend. Put it on your list and the chances are greater you will get it done.

Why does writing things down work so well? Well, think about the place you live in. It all began with a drawing plan. Someone made a blue print. Then they set up a schedule of things to do in order of importance, and *poof*, you now have a building. Think if you wanted to do an addition to your house or plant a garden. If you make a blue print or a design the chances of it happening increases. It is not a secret that great people in history have often made lists of goals and plans, because writing things down worked.

OK, we need to put down first the things that have to be done at a specific time because we have a commitment already. Next comes the three most important things. Remember, getting to work is one of the most important items on your list. When you accomplish your most important thing of your day, just think how wonderful you will feel.

And lastly, those things we would like to do: It is important to keep track of these things because the likelihood of actually doing it is stronger once you have put in it writing.

SO START MANAGING YOUR DAY INSTEAD OF HAVING IT MANAGE YOU. ANOTHER TIP IS TO BREAK YOUR DAY INTO SEGMENTS. OFTEN WE FEEL OVERWHELMED. HAVING YOUR LIST WILL HELP WITH THAT, BUT SO WILL GOING THROUGH YOUR DAY FROM BREAKFAST TO LUNCH AND LUNCH TO DINNER AND DINNER TO BEDTIME. SOMETIMES YOU WILL JUST HAVE TO SAY TO YOURSELF, LET ME GET THROUGH THE NEXT 5 MINUTES. TRY TO STAY IN THE PRESENT MOMENT. IT WILL LET YOU ENJOY YOUR DAY MORE AND ALLEVIATE ANXIETY.

How to Manage Your Day Homework

Manage your day instead of having it manage you. Making lists of things to do is very effective for high-level executives, homemakers and students. In other words, everyone benefits from scheduling their day. Think about a busy person who seems to get so much done. How do they do it? Perhaps they have a schedule. How many times could you have saved time by running errands while you were already out in the area? Having a list will stop you from having to run back out and thus give you more free time.

1) Perhaps on Sunday night you could make your list of scheduled things for the week. Maybe you'll want to pencil in some chores because things can change as your week progresses.

2) Stick to your list and especially pay attention to what you have determined to be the most important tasks.

3) Look for those opportunities to do the things you want to do but don't need to be done. Perhaps you want to call a friend or read a book. Take the opportunities to do these things. We need them to re-energize us.

4) Take your lists seriously. Think of them as a contract you have made with yourself, but don't stress over it. Remember, contractors don't always meet deadlines. Give yourself some leeway, too.

5) Notice the difference having a list does for your time management. Also notice how much more you are getting accomplished.

6) Praise yourself for being more organized and committed.

Notes

Lesson 13

SAYING NO

NO. When do we learn to stop using that word? Think of a two year old. All they say it seems is "no". Well, of course the two year old is totally self-centered as he/she should be, and "no" is a good word at that age, even though it can be annoying to hear repeatedly. However, at some point we forget how to say no when people make demands on us. Often, because we have panic disorder, we tend to be people pleasers and perfectionists. But what we often don't realize is that by not saying no we do harm to ourselves and others. Think about the resentment that may be building up when you do something you really don't have the time to do for someone else. Somehow we often feel if we say no that we will not be liked or that we are being like selfish two year olds. Guess what? We are not if we put the no's into perspective.

When someone asks you to do something for them ask yourself these questions:

1) Is this something that is of immediate need?

2) Can I do this perhaps at another time when it will be more convenient for me and not stress me out?

3) And most importantly, is this person making an unreasonable demand?

If someone has immediate need and you just know you have to drop everything and help them, do it if it makes you feel good. There is great satisfaction in helping others. However, you will find that most things will fall into the other categories of " it can wait". If this isn't the case, consider it an unreasonable demand. If it is something you want to do for someone but it can wait, say, "No, not now, but maybe..." and suggest a time that is convenient for you.

If it is an unreasonable request of something you just don't want to do, say NO. It's that easy! Do you need to make an excuse for saying NO or try to give an explanation? NO! Remember, they are the ones requesting your time, and your time is valuable. NO means NO and needs no explanation. Too often we feel so guilty that we feel it is necessary to give tons of reasons why we said NO. Do we owe them an explanation? Not really. Who is the one asking the favor and use of your time? Has anyone every said NO to you? Observe the behavior of others who know who to say NO to gracefully and imitate them. We learn two things from observing people- what to do and what not to do. So make yourself a student of people's behavior that you admire. Say NO with confidence and value your time as much as you would value someone else's time. You are just being assertive and not obnoxious. Understand that when you make such a huge change in your behavior people may not understand at first. Don't let them make you fall into the guilt trap and having you saying yes when you really want to say no. Value yourself, and other's will value you too.

SAYING NO HOMEWORK

1) When someone asks for a favor, stop for a second and ask yourself, "Is this something that needs to be done immediately? Can I do it at a more convenient time? Do I really want to do this at all?"

2) Practice ways to say NO with conviction.

3) When someone presses you continue to say NO graciously and with conviction.

4) Stand by your decision to say NO and feel good about it.

5) Realize you have value as a person and your time is valuable. Praise yourself when you say NO because you value your time.

Notes

Lesson 14

LETTING GO OF GUILT

Guilt is one of those things that holds us back from so many things and wastes much of our time that could be spent more productively. Does guilt really serve a purpose? Sometimes guilt can stop us from doing actions that will harm others or ourselves, but most of the time people feel guilty over things that they have no control over. What type of guilt are you holding onto and is it really serving a positive purpose? Do you feel guilty for the way your children turned out? Are you guilty that you have not lived up to other people's expectations? Are you guilty about things you've done way back in the past? Are you guilty about things you haven't accomplished? What guilt are you hanging on to and is it really serving a purpose?

Most of the time guilt robs us of enjoying the present or it makes us do things we really don't want to do. We also tend to overcompensate for our guilty feelings and become martyrs, and what does THAT accomplish? The people around us don't really enjoy seeing us behaving like martyrs and they tend to see us as negative people. So instead of accomplishing something positive, we actually twist our personalities into something that people don't want to be around. Often we make others feel guilty for being in our company because we are overcompensating and placating. Another thing we can do with our guilt behavior is make people spoiled and dependent on us. Ask yourself if making others dependent on you makes you feel a sense of accomplishment. Or how is it serving you? And how is it serving THEM?

Some people seem to enjoy carrying their guilt around like a badge of honor. So they think it is serving them. But think about it. How better can you serve yourself, and others too. Let go of the guilt. If you did something to make amends for, make peace with yourself. It's done. Why run it around and around in your mind when it's something your can't change? Set things right in your life and realize that we all make mistakes. It is part of being human and it makes us grow. So don't get stuck in the guilt mode. Grow past it. Do the amends that must be done. Learn from it and move on.

If you don't like getting caught in a phase of growth development and you are stuck there, you need to grow. Life is for learning and growing. So start now. Examine those things you feel guilty about and ask yourself these questions:

• How can I make amends?

• How can I avoid making the same mistake?

• What did I learn from the experience?

• Do I really want to stay trapped in a guilt phase?

• Is my guilt serving me somehow? And if so how?

NOW LET'S LET GO OF THE GUILT. REMEMBER THAT YOU ARE HUMAN. YOU MAKE MISTAKES. COULD YOU REALLY STAND TO BE AROUND A PERFECT PERSON? THAT WOULD BE PRETTY ANNOYING. SO EMBRACE YOUR MISTAKE. LEARN FROM IT AND MOVE ON. LIFE FREE OF GUILT IS BETTER FOR YOU AND THOSE AROUND YOU TOO!!!!!

Letting Go Of Guilt Homework

Often we are carrying around unnecessary guilt so lets determine if our guilt is serving a purpose and also take action to let go of guilt.

1) Think about the things that make you feel guilty and make a list.

2) Ask yourself what the circumstances around your guilt were? Also, how long have you been carrying it around?

3) Decide how you can make amends for your guilty actions and then do it!. Perhaps you can apologize or write a letter to the person you offended or injured.

4) After you have made amends, forgive yourself, even if the person is unwilling to forgive you.

5) Think how the guilt is making you do things presently that you don't like doing. Eliminate that behavior because you are now forgiven.

6) See the joy you now have when you let go of guilt and how much more productive your life will become without the guilt.

7) Praise yourself for taking positive action and doing all that you can do.

8) Find that sense of peace that comes from letting go of unproductive guilt.

Notes

Lesson 15

FORGIVING OURSELVES

Forgiving ourselves and putting the past behind us is most helpful to recovery. Often we are hanging onto guilt that is not even ours to keep. Ask yourself if you are not forgiving yourself for something that really wasn't your fault. Or are you still holding on to a past mistake that you have long ago made amends for over and over again? So many of us tend to do this: we stay trapped in the past and/or let a mistake made years ago determine our current behavior.

Remember, you are only human and have made mistakes and will continue to do so in the future. But the most important things mistakes teach us is not to repeat them. Then the mistake is a lesson and makes us better. So start to embrace your mistakes and see them as lessons. This process will also make you less judgmental of others.

So many people carry baggage around with them. This isn't necessary and it tends to determine their current behavior. Let's look at an example of how guilt can actually make the present and future worse. For example, maybe you had a child out of wedlock or went through a divorce where children were involved. As you look at this child you feel guilt for what you feel you have put him/her through, so you tend to overdo for this child out of guilt. The end result could be devastating because it could very likely lead to a spoiled child. You should rear this child free of guilt, knowing that you have done your best and can forgive yourself for your past errors.

We have all made mistakes. This is just one. But it can devastate those who make it because we often take guilt into a new relationship from past ones. LET GO OF THE GUILT! Generally there are so many factors that lead us into past errors, so how do you start to let go?

First, acknowledge that you are human like everyone else. You've made mistakes, (we all have), and if you're fully human, you will continue to make mistakes.

Second, understand that your mistake is long since forgiven. You just have not forgiven yourself.

Third, realize you are worthy of forgiveness from others and yourself.

Fourth, realize that you would most likely forgive someone for doing what you see as unforgivable action in yourself.

So ask yourself if you've done all you can to make amends and apologize for this past action. If the person has passed away, write them a letter. Realize that they have forgiven you and really want you to forgive yourself. Life is a learning process. Joy, sorrow, mistakes, guilt, and forgiveness are all part of the journey. So learn to forgive yourself for being human and who you are, embrace the new you that the past error has made you and go forward and onward to life renewed. Just think how holding onto the guilt serves no positive purpose but how letting go allows you to grow and get better. It enables you to give more to others, even those you may feel you need to make amends to. In short, make your error work for good. Embrace it and let it bring out a new you that forgives yourself and now has made you a better person because of those actions.

Let me tell you a story about a man with two children on a train. The children are young, and being unruly, the father seems to be neglectful. He is letting them just run all over the place, annoying the other passengers on what is a very long trip. One annoyed man thinks to himself, "How can he be such a bad parent?" A woman asks the father if she could assist him with taking care of his two children. Tears roll down his eyes as he gratefully says yes. He goes on to explain that they are usually wonderful children but they have just buried their mother and are a bit out of it. At this point many people offer to help him with his children. Think back to what you need forgiveness for. Were there circumstances in your life that helped to create your behavior. Would people respond differently to you if you they knew your whole story?

How many times have you felt guilty for not going somewhere due to anxiety? If others had your anxiety, chances are they too would have missed some events. Don't hang on to the guilt because it does not help you with the anxiety. It just fuels the anxiety.

Think of how the guilt serves no purpose. Really all it does is keep you more anxious, less confidant, and it holds back your recovery. When we realize that a behavior no longer serves a purpose, it becomes easier to let go of. So let's start healing and let go of the guilt and forgive ourselves.

REMEMBER, YOU ARE PROBABLY A VERY FORGIVING PERSON TOWARDS OTHERS, SO WHY DON'T YOU GIVE YOURSELF THE SAME RESPECT AND UNDERSTANDING. FORGIVENESS IS SO HEALING. LET THE HEALING BEGIN.

Forgiving Ourselves Homework

1) Think about what needs forgiveness.

2) Make a list of these things.

3) Ask yourself how you can make amends for these actions.

4) Do it! Make amends.

5) Realize you are only human and everyone makes mistakes.

6) Ask yourself if you would forgive someone for doing the same actions you seek forgiveness for from yourself. If not, why wouldn't you forgive them? Decide if it is really worth holding on to the anger. When we really probe and ask ourselves questions, we will find it is best to forgive because it heals us.

7) Do something physically symbolic to acknowledge you are forgiven, such as writing the actions down and ripping them up and throwing them away. Now it is in the past where it belongs.

8) EMBRACE YOUR HEALING THAT IS TAKING PLACE FROM THE FORGIVENESS. FEEL THE PEACE.

Notes

Lesson 16

FORGIVING OTHERS

Once again you need to ask yourself the benefits as you think about those who you need to forgive. Over the ages spiritual leaders have preached forgiveness and often we find ourselves saying, "But I can't forgive," or, "I will forgive but never forget." Why do you think those great spiritual leaders preached forgiveness? To let wrong doers keep doing ill to others? NO. They preach forgiveness so that we can heal; so that the wrong doers do not have the ability to continue hurting us.

When you begin your journey of forgiving others, ask yourself if they have made restitution with you. And if not, can I accept this knowing that I am not at fault? Think about someone who abused you or who betrayed your trust. What can you do? Can you change this person? Usually not. But what you can do is CHANGE YOUR RESPONSE to this person. You can still forgive what seems to be unforgivable knowing that it will do you good. It truly will benefit you if you let it.

How do you forgive, you might ask? It is so hard. Well, what you are carrying around is also hard. The pain, the hurt, the anger and resentment. You are probably saying I am entitled to my pain, my hurt, my anger and my resentment. Yes, you are. But do you want it to continue to hurt you? Think on this. Why forgive? What is in it for me? Peace, acceptance, a chance to move forward and get on with the joy of life. That is what the great spiritual leaders knew when they said forgive your enemies. By holding onto your anger you are still giving the person or people who hurt the chance to do it to you over and over again.

Think back to a good memory in your life; a time when you had a wonderful, peaceful day. If you can't think of one, imagine how nice it would be to have such a day and how you would want this experience over and over again. Now think of a time when someone did something to you that you find unforgivable. Do you really want to experience that again and again? So let's start learning to forgive, to let it go so we don't have to relive things we don't like and can start to live the things we DO like.

First, have no expectation that the person or people who did you harm will every repent or change. That is not for you to make happen; it is for you to just accept. Realize they had faults and harmed you and that you no longer have to put yourself in that situation. You can choose to put them out of your life now. You may have already done this physically. You may no longer see them, but mentally and spiritually you have to let go.

Mentally, do images of the abuse or wrong still haunt you and keep you in a trapped state of anger, hate, and resentment? Accept that wrong things do happen and that you can now take this experience and turn it into good. What did those people teach you? They taught you how not to act; how not to treat others. Maybe you are a kind, warm, loving person because you would never want anyone to feel as badly as that person made you feel. See the good that came out of the experience. See it as a lesson, unfair though it may. See the end result. It is who you are; it is part of you. Embrace it and make it your own. Make it something good.

Forgiving Others Homework

This may be one of the most challenging homework assignments but also one of the most beneficial. When we put past hurts aside, we can begin to enjoy the present and the future so much more. So let's start this assignment with the purpose of having a richer, happier live. This who have done you wrong have robbed you enough. Don't let them take anything more from you. Start to forgive because it is beneficial for you.

1) Remember the past so that we can start to let it go. Write down the actions that need to be forgiven. You may want to recall details of people, places, things, and actions so the exercise will be more meaningful to you.

2) Give yourself permission to feel the anger. It's OK. But realize we are going to let it all go because that is what is best for us. As you feel the hurt and anger, say to yourself, "Do I really want to relive this over and over?" Hopefully your answer is NO.

3) Ask yourself if this person will ever make amends. If not, say to yourself that its OK. Tell yourself that you will want to go on with your life. It is their problem, now. It is my opportunity to grow.

4) See the opportunities that you have gained from the harm done to you in the past. Maybe you are a better parent or spouse. Perhaps it was those painful actions that put you on your current career path. Think how those past actions have shaped you for the better. Remember, we can see good in anything if we look hard enough.

5) Find something to praise and celebrate because of the hurt that's been done to you. Does it make you more compassionate and understanding? Have you met some wonderful people due to those past actions? If you look hard and long enough you will find the positive.

6) Do something symbolic. To let go of the past, burn or throw out what you wrote down as you remembered those actions in step #1.

7) Hug yourself and reward yourself for being such a loving and forgiving person. Think how bitter people get when they refuse to forgive. Be thankful you are letting go of resentment, anger and fear and in its place you will peace, serenity, and happiness.

Notes

Lesson 17

SET BACKS

Let's suppose you have been doing all the right, constructive things like relaxation, positive self talk, facing those fears, and WOW, it worked! So why is the panic monster coming back? Understand that setbacks are common and you are not ever going to go back to the beginning again. Understand that you have programmed your body to react in a panic way. It will take constant practice to reprogram yourself. So just think of the setbacks like phantom pain; they are not real. It is just a conditioned response that you can beat if you continue to practice the techniques we've talked about. Think of it this way- if you had not made progress, you would not have had a setback! Think of setbacks as sure signs of progress!

So if we chose to embrace setbacks as proof of progress, they show us we are doing better. Setbacks are good for us because they give us a chance to practice our skills again, and this will allow us to see just how much we have grown.

When a setback does occur ask yourself a few questions such as:

• Did I get enough rest?

• Did I eat well?

• Is there something bothering me and really causing genuine anxiety?

• Did something trigger this anxiety?

• Do I feel physically sick or tired?

• If female, are you premenstrual? (Many women say they have an increase in anxiety when premenstrual.)

When you ask these questions, you may find that your setback was just because you were tired. Or maybe you are experiencing just the good old memory of panic.

MOST OF ALL, REMEMBER THAT YOU CAN'T HAVE A SET BACK WITHOUT PROGRESS AND THEREFORE- SET BACKS = GROWTH SPURTS

Try changing your thinking about setbacks altogether. This is a good time to look at your journal and see just how far you have come. Remind yourself that you have already been through the worst. It will never get that bad again... NEVER!

Think again of an athlete having a bad day on the playing field. Maybe the athlete will have problems for a week or a month. Think of the Olympic athletes. Their careers begin well. If it didn't, they wouldn't qualify for the Olympics. Does this mean they will do well for as long as they are serious minded athletes? Of course not. Their careers have ups and downs. And when their career finally comes to a close, do they just shuffle off into the sunset? No. Most do not. Most Olympians go on to successful years of training others. Their setbacks don't stop them or discourage them. Nor should setbacks discourage YOU.

Setbacks can also be viewed as opportunities (remember our vocabulary changes?) to practice our coping skills. The skills we are learning will not only help us with panic, but also will help make our lives better after panic, too. We will be more positive and handle situations better because we have tools to use in times of stress. Stress is part of life and it can be a motivating force driving us to improve, grow, and use positive action. Just think how much more informed you are over people who never had panic disorder. You have practiced coping skills to prepare you for life's curve balls. Those who have not have yet to learn them!

TRUST YOURSELF AND YOUR PROGRESS AND REALIZE YOUR SKILLS WILL NOT LEAVE YOU. THEY JUST NEED TO BE BROUGHT BACK OUT AGAIN WHENEVER YOU NEED THEM. SO SEIZE THIS AS AN OPPORTUNITY TO PRACTICE AND GROW EVEN MORE.

SETBACKS HOMEWORK

If you are experiencing setbacks, congratulations. This is a sure sign of progress. Imagine you are learning to roller skate. If you don't fall down, you have not pushed yourself out of your comfort zone. It is the person who attempts to skate backwards or do a difficult spin who will fall down. The one who chooses to stay in their safety zone will just skate around in circles, never learning anything new. How boring! So once again, CONGRATULATIONS. You have just pushed yourself and are now reaching new limits. Just imagine how wonderful it will be when there are no limits.

1) See your setbacks as a sign of progress. Push back those feelings of discouragement and realize you can't have a setback without progress, nor can you have real progress without setbacks.

2) Ask yourself if there is a reason for the setback such as:

Not enough sleep, improper nourishment, or a stressful life event.

3) Use your tools to push forward with your setback. Just because today you could not do the task you wanted does not mean that tomorrow you will not be able to accomplish it confidently. Remember, you are only having a setback because your tools have brought you forward. So don't allow yourself to distrust the skills you have learned.

4) Continue to keep the faith in yourself and your progress. Tell yourself it is just a setback and it will go away.

5) Praise yourself that you have come so far that you can now have a setback. See it all as good and embrace it and accept it as part of getting better.

Notes

Lesson 18

GROWTH SPURTS

We have talked about set backs. Now let's discuss growth spurts since we now know they often go together. Often you will hear someone say they feel that they have taken 5 steps forward and 2 steps backward. Once we have tasted going to a fearful situation or place free of anxiety, we feel let down when the panic returns. Be assured that this is normal. Remember, you are reprogramming your thoughts and this takes time and practice.

At first you may actually be afraid to be cured of your anxiety, even though the anxiety is horrible. We get so used to it, change can be a fearful undertaking. We tend to resist change, even though change is a natural part of our growth. But change is certain to come to all things living, so accept it and be grateful that you are changing for the better.

When you have a set back ask yourself a few questions such as:

• Am I tired?

• Did I eat well?

• Did I have enough sleep?

• Is there something bothering me?

Also, ask yourself how having anxiety serves me? Does it give me an excuse not to make decisions or not to do things I want to do but am afraid to do? In other words, does the anxiety stop you from having to grow up a bit and make some major decisions and therefore the anxiety seems to be serving you in some way? Please don't think we are saying you need to grow up and snap out of it. Just understand you are having growth spurts and enjoying them. So make sure that you don't hold onto the anxiety because at one time it seemed to serve you. In some way we feel we have lost so much, and yet we generally do things to benefit ourselves. In some way the panic has been a support for you. But now you need to see that you have nothing to gain from it anymore.

Perhaps you had a fear of failure or you were afraid of who you may had become without anxiety. Well, turn that around and ask yourself if you really want to stay the person you are with anxiety. What do you really have to lose by continuing to grow? Understand that you will be full of all types of emotions anger, rage, resentment, joy, happiness and excitement. This is all normal as you grow and change. Just take each emotion as it comes and realize it is only temporary and bringing you towards a wonderful end. A new person is breaking out of the cocoon and is about to fly.

It is good to see that our condition has produced some positives. Perhaps you are more understanding, patient, and tolerant of other people's weaknesses. This will not change if you let go of the anxiety. Choose the lessons you want to keep from your journey with anxiety disorder and let go of the rest. We learn from our behavior what to do and what not to do. You have learned new skills to deal with your anxiety and through using them and hard work you are having a growth spurt. Congratulations!

Let your loved ones know this is all part of your recovery and it will all be worth it. It will help you too if you open up and let them know that you may be a bit more touchy at this time of growth. It will also make you feel more comfortable to tell others. They will understand and appreciate your honesty more than you can realize.

If you find yourself getting nervous about your growth, accept that emotions are changing. This will b exciting to you and excitement is a stimulate. Be aware that feeling stimulated can mimic anxiety. You are not experiencing anxiety. You are experiencing excitement for your own personal progress.

So go with the growth and understand that it will not happen overnight. Your growth is happening one day at a time and it's great! Enjoy this time of healing and growth and realize it is letting you now address new issues that you once suppressed with a panic attack or OCD behavior. Isn't it wonderful to now be free to feel them? See it all as good and congratulate yourself on your growth.

Remember, if you are not growing, you are not really living. Enjoy your new found freedom.

GROWTH SPURTS HOMEWORK

Growth spurts are times of wonderful changes and a new sense of freedom. Freedom can be a bit intimidating because it brings about new responsibilities. At this time of growth be patient and kind to yourself when you find new emotions surfacing.

1) Ask yourself, "Am I feeling some anger?" If yes, realize you are angry at the panic. Try to think of ways you can now turn that anger into a positive force. Anger at the panic can now be your motivation instead of the "fight or flight" response you are so familiar with.

2) Let loved ones know that you are growing and having some "growing pains." Sharing this with them will help you and those around you with some of the mood swings you may experience.

3) Keep notes on things that may trigger some mood swings. This will help you to recognize them and address them as they occur. Just as you journal to keep track of things that cause panic, now notice things that cause mood swings. This awareness will help you keep those mood swings under control.

4) Ask yourself how the growth spurt is serving you better than the panic. Really think about this because when something serves us in a positive way, we desire more of it and we want to keep growing.

5) Evaluate all that you and your loved ones have gained since you have grown. Perhaps your safe person has more freedom to leave you alone. Maybe you are making it to more outings and enjoying them. Are you able to socialize more now than you were before? Do you find yourself making decisions that no longer revolve around whether or not you will have a panic attack?

6) Reward and praise yourself for all your hard work and progress.

Notes

Lesson 19

VISUALIZATION

Visualization is an extremely powerful tool. Those who become successful in whatever their endeavor might be most likely make visualization an important part of their lives. Many studies have been done on visualization. Here's one example. Three groups of people were randomly chosen. The aim of this particular study was to determine if visualization could affect the scores of each group making basketball free throws. Group #1 practiced one hour each day on the basketball court. Group #2 was not allowed to practice shooting baskets like Group #1, but--and here's the important part--they VISUALIZED making baskets for one hour every day. They simply sat in a chair, then visualized stepping up to the free throw line, picking up the ball, dribbling it, feeling it, feeling their stance as they prepared to shoot, firing the ball at the basket, and, finally, watching the ball sail into the basket. Group #3 was not allowed to practice or visualize.

At the end of one month they had all three groups make free throws. After comparing this second set of scores to the first set, they were astounded to find that the group that visualized rather than actually practiced on the court had the same level of improvement as those who had! Group #3 who was not allowed to practice or visualize, showed no improvement! Visualization is a powerful tool, so let's get started!

OK, we are going to relax ourselves before we begin some positive visualization. This technique will help you to go to a safe place in your own mind when you need to unwind, feel panic coming, or just want a great night sleep.

But prior to starting this I want to show you the power of our imagination. I want you to imagine yourself holding a bright yellow lemon. You are now going to cut the lemon. Do you feel the juice running down your fingers? Did some of the juice get in your eye? Did you feel a sting when that thought crossed your mind? Now smell the lemon. Let the aroma fill your nostrils. Breathe it in. Now bite into the lemon. Is your nose wrinkling up? Is your mouth salivating from the thought of tasting the lemon. Are you feeling the tart taste of the lemon? See how powerful your imagination is for you. Now let's use that imagination to make our lives more positive, more confidant, more fulfilling and enjoyable.

To get ourselves in a more receptive state we will start by focusing on viewing scenes through a third eye. What I want you to do is lick your finger and place it on your forehead to make an imaginary third eye. Put your focus there in your mind's eye and see yourself going down an escalator. As you ride down slowly, you are feeling more and more relaxed. Picture yourself at a landing. Take a deep, slow, cleansing breath as you step onto the next escalator that will take you down a bit more. You are getting more and more relaxed. As you step onto the next landing you see yourself as you want to be. The person you want to become. Happy, confident, vibrant, unafraid. Now take the next escalator down as you continue to see your wonderful self going down the escalator and feeling more relaxed.

Eventually we find ourselves in a beautiful place. It can be a cabin in the woods or a sunny day at the beach. Maybe you are lying or sitting by a warm cozy fire as the embers glow. Go to your favorite place in your mind's eye. This is your safe place, a place where you can go to dream and be whatever you want to be, free of limitations, free of fear.

As you see yourself, start to feel the things around you. Taste the tastes, smell the smells, hear the sounds, and enjoy it with all your senses. You are smiling and content.

Now you have this place. It's yours; you own it and no one can take it from you. It is your own place; a place you can go anytime you want to feel safe.

We will slowly re-ascend the escalator as we leave this place, knowing it is our private place that we can go to anytime we wish...

Now we take the first set of escalators back up to our regular conscious state of being. Feeling refreshed as we get to the first landing, we feel revitalized and happy. We smile as we take the second escalator back towards our world. We are feeling ready to face new challenges, feeling confident because we have our own special secret place. Finally we take the last escalator up and know that we are definitely able to handle any situation. We now step off the escalator, knowing that we are alive, happy, and ready for success; ready to face the day.

VISUALIZATION HOMEWORK

1) Think about where you want to go when you start your visualization. Is it to the beach? The woods? A cabin?

2) Get in as relaxed a state as you can and start deep breathing.

3) Focus through your third eye.

4) Go down the escalator, relaxing more and more as you descend.

5) Think about positive suggestions you want to add when you have reached the third level. For example, would you like to quit smoking or lose weight? Make the suggestion at this time. Think how wonderful it will be to have clean smelling hair and clothes when you quit smoking. Imagine yourself wearing the clothes you want at your ideal weight. Make all the suggestions in terms of what you will gain, not what you will lose. We are more receptive to what is in it for me as opposed to what do I have to give up.

6) Use this visualization technique 3 to 4 times a week more if you are so inclined. This is your time to feed your head with wonderful, positive thoughts. Remember when you were a child. You would daydream and feel wonderful. Now you are using a similar technique but to an even more positive end. This visualization technique is moving you on a forward path. Do it often and use it to change behavior for the better.

Notes

Lesson 20

SETTING GOALS

Goal setting is so important; not only when overcoming anxiety, but in all of life. Remember, we told you life would become better after anxiety. Well this is one of the skills you will learn that will help, and aid you in so many ways..

Remember that most truly successful people are goal setters. At some point many of us forget how to set goals. Maybe life has sent you a few curve balls that got you off your path and so you gave up on goal setting. Well, now is a wonderful time to go back to it. Look at the house or apartment you live in. How did it get there? Well first it was an idea in someone's head. Then they drew up a set of working plans. Then builders were hired to construct the foundation, the wiring, the plumbing, etc. Imagine how many people were involved and the goals they all had to set to have the blue prints done in time to have the foundation laid by a certain date and so on. Do you think that whole process went along without any glitches? NO. Ask anyone who's had a new house built and most likely it was not completed on schedule. But they are living in it, aren't they? How did that happen? Goals were set and the builders followed the plan.

You're probably telling yourself at this point that having to follow plans to build a house is obvious. But is it? It seems that we can accept the obvious when someone else is doing it, but we never seem to grasp the idea that we have to work toward success in an organized way when WE are the blueprinters and builders!

The power of writing goals down makes them more likely to happen. We are programmed to believe things in print than we are to just think about them. Take your ideas out of your head and write them down! If you have a Palm or Visor or any other kind of PDA, write them down on the Memo Pad! Carry your ideas with you. Review your ideas whenever you need to. Be determined to conquer your anxiety.

Here's a plan to write down your goals.

1> Think about weekly goals, and write your monthly goals for the rest of the year.

2> Next, do a five-year plan, a ten-year plan and a twenty-year plan.

These simple but important steps will keep you focused daily. It will also push you to stretch yourself because now you have a five, ten and twenty-year plan. Stretching and growing are a part of life and writing goals down is like making a contract with yourself.

WHEN YOU WRITE YOUR GOALS DOWN YOU HAVE RAISED YOUR CHANCES OF SUCCEEDING. WE BELIEVE IN YOU AND KNOW YOU WILL SUCCEED.

Setting Goals Homework

1) Sit in a quiet place and really think about your goals.

2) Start with your weekly and monthly goals. Make a map for the entire year.

3) Next make goals for where you would like to see yourself in 2 years or 5 years. Act as if you don't have limitations. Pretend that anxiety, money, and time are not factors. Pretend you have a fairy godmother that is removing all obstacles in your path. You may say, why should I not consider my limitations? Good question and we have an answer. These are goals and you will find a way to deal with challenges when they arise.

4) Repeat these steps for a 10-year goal plan.

5) Cut out pictures of things on your goals sheet. For example, if you want a car, cut out pictures of the car you desire. If you want to go back to college, get catalogues for colleges. ACT AS IF IT IS GOING TO HAPPEN.

6) Check off your goals as they are accomplished and celebrate at each accomplishment.

7) EXAMINE YOUR GOALS MONTHLY. YOU ARE PROGRAMMING YOUR HEAD WITH GOOD THINGS.

Notes

In Closing

Congratulations! You have finished the workbook. We applaud you on all your progress and accomplishments. You have made permanent changes in your life for the better and we have confidence you will continue to succeed, learn and grow.

~The End~

---