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You will be diagnosed with GAD if your worry and associated symptoms interfere with your ability to function occupationally.
If you had a traumatic event in your life, you need to return to the actual situation where the trauma occurred. If that's too hard, break it down into smaller steps.
Face the situations you have been avoiding in your mind first.
THINGS THAT MAINTAIN YOUR PROBLEM:
(1) Avoidance of Phobic Situations.
(2) Anxious Self-Talk. Your internal voice.
(3) Mistaken Beliefs.
(4) Withheld Feelings.
(5) Lack of Assertiveness. Not expressing your desires.
(6) Alcohol/Cigarettes/Drugs.
(7) No sense of purpose.
(8) Muscle Tension. Shallow breathing.
Don't blame yourself for your problems. Is it not true that you’ve done your best up to now with the knowledge you had? Its not your fault! You didn't know that even taking Ecstasy would cause you problems.
One good thing about your problems: “Suffering is the greatest motivator of growth!”
After practising deep relaxation for a few weeks you will be more relaxed more of the time. Otherwise, even sleep can fail to break the cumulative stress cycle unless you've given yourself permission to deeply relax while awake.
People who are fearful breathe too shallow. This leads to decreased carbon dioxide in the blood making LIGHTS SEEM BRIGHTER. Notice that you hold your breath when stressed. That's a bad sign! Just 3 deep breathing minutes can help you deeply relax.
Inhale through your nose into the bottom of your lungs to the count of 5. Hold your breath to the count of 5. As you exhale to the count of 5 allow your whole body to just let go, and say “Calm” silently to yourself. Then take 2 normal breaths, then do it again. Continue for 3-5 minutes. Do this exercise when you meditate. Visualise yourself in a peaceful scene. On a quiet beach, a stream in the mountains, a cozy fireside on a cold winter night.
Also do progressive muscle relaxation with deep breathing.
You need to have the following downtimes in your life to remove stress:
One hour per day.
One day per week. (Sundays).
One week out of 3 months.
Downtime can be lying on the sofa doing nothing, meditating, listening to relaxing music or soaking in a Jacuzzi.
Earning money/perfectionism is not so important as a simple and balanced lifestyle.
If you are short on time, only do the essential tasks for the day. This would be physical exercise - its the most important thing! And meditation!
Then comes spending time with your partner/family.
Postpone all other non-essential tasks.
If you have some undesirable yet essential jobs, promise and define a special reward for completing them.
If your image of yourself requires you to be nice all the time and always available to everyone, then there is probably no limit to what others will ask of you!
Check your resting pulse rate, it should be below 70.
Get a cross-trainer or an exercise bike.
Play golf with someone, anyone!!
Panic is an entirely natural bodily reaction, simply out of context. What your body goes through is not dangerous!!! Just let your body go through the reactions.
Its an opportunity to learn to cope with your fears! Focus on concrete objects around you.
Count backwards from 100 as a way to distract yourself.
ULTIMATELY YOU NEED TO DIRECTLY EXPERIENCE ANXIETY AND LET IT PASS IN ORDER TO HABITUATE IT. THAT'S THE ONLY WAY TO BUILD CONFIDENCE.
If you can get angry with anxiety the moment it arises, you may stop it from building any further. Say things to your symptoms such as “Get out of my way. I have things to do! To hell with this - I don't care what other people think! This reaction is ridiculous - I'm going into this situation anyway!”
Or you can just pound or scream into a pillow, or in your car, with the windows rolled up.
Take a hot shower. Get hugs from your partner.
WHAT TO DO IF THE PANIC GOES ABOVE YOUR PERSONAL POINT OF NO RETURN:
(1) Get out of the situation if possible.
(2) Don't fight your symptoms. Panic is not dangerous and it will pass.
(3) Move around, or engage in physical activity.
(4) Touch a physical object to 'ground' yourself.
(5) Take a tranquiliser as a last resort.
Accept your symptoms and dont flee unless its really bad. Practice abdominal breathing.
Use a coping strategy : “I can get through this, its not dangerous, it will pass. I wont let it rule my life!”
Use the letter on p.132 of the workbook if necessary to write to a friend or loved one.
Exposure and Desensitization:
You need to enter a phobic situation while in a relatively relaxed state. If your anxiety gets too much then retreat from the situation temporarily and return ASAP to it.
The goal of exposure is to learn to remain in the phobic situation and be calm at the same time. Keep with your abdominal breathing. Focus on your arms and legs to distract from your thoughts.
NOTHING WORKS BETTER FOR OVERCOMING A FEAR THAN FACING IT.
Exposure therapy requires a big commitment. Take the risk to face situations you would normally avoid. Tolerate small amounts of discomfort and try and remain in the situation as long as possible. When you start to feel anxious, say to yourself “I need this anxiety - I cannot desensitize without feeling it!” YOU NEED TO FEEL IT TO GET BETTER!
Persist every day for years if necessary.
Setbacks will happen. One bad day is not the end of the world.
Don't ease off with your exposure until you are fully cured.
3 month GOAL: To have trading systems that can earn me a living.
I can learn to handle any scary situation if I break it down into small steps.
HIERARCHY WORKSHEET:
(1) Be in a public place (restaurant, sports, friends) without glasses for 1 minute.
(2) As above 3 minutes.
(3) 5 minutes.
(4) 10 minutes.
(5) 15 minutes.
(6) 20 minutes.
(7) 30 minutes.
(8) 1 hour.
(9) 1.5 hours.
(10) 2 hours football, golf, yoga, restaurant, poker tournament (without glasses).
Visualize yourself in part 1 of your hierarchy. Imagine yourself feeling calm and confident. If you can do that, try part 2. After doing this for a minute, retreat to a peaceful nature scene.
Expect your eyes to feel worse some days for no reason. THIS WILL HAPPEN.
Positive Coping Statements:
(1) Preparing to face your phobia, the day before or the hours before:
“By taking this step now, I’ll eventually be able to do what I want.”
“I know I’ll feel better once I’m actually IN the situation.”
“There’s always a way to retreat from the situation if I need to.”
(2) First Confronting and Exposure to your Phobia:
“I can take some abdominal breaths and take my time.”
“I can monitor my anxiety level and retreat from this situation if I need to.” “As I continue to practice exposure, it will get easier.”
(3) Coping with Feelings that come up During Exposure:
“These sensations are just a reminder to use my coping skills.”
“I can take some abdominal breaths and allow these feelings to pass.”
“This is just adrenaline - it will pass in a few minutes.”
“Its always okay to retreat for a while if I need to.”
Self-Talk:
What we say to ourselves in response to any particular situation determines our mood and feelings. Negative self-talk is a series of bad habits, that's all.
When you decide to avoid a situation its probably because you ask yourself :”What if I can't handle it?”, “What will other people think if they see me anxious?”
Try and notice that you are asking yourself such questions, that's the first step! Well done!
Try answering :”I can handle this.” , “So what, these are just thoughts.” ,”Breathe, let go and relax.”
Try and accept what's happening, even though its uncomfortable. Don't do any scary self-talk, like “Oh no, it's happening again.” . “I have to get out of here , now.”
Don't think that there is something inherently wrong with you, it's not true! You CAN do it. You WILL be able to.
Don't try and be pleasing and nice to others, REGARDLESS of what they do.
You need to try and turn your thinking around. Ask yourself: (1) What is the evidence for this?
(2) Is this always true?
(3) What are the odds of this really happening (or being true)?
(4) What's the worst that can happen? What's so bad about that?
(5) Are you being objective and looking at the whole picture?
For example :
What will other people think if they see me anxious? (1) Has anyone every said you look anxious?
(2) Sometimes I think I will be anxious and then I am not.
(3) 5% of people say I look tired or scared.
(4) They might say I look tired, but it will pass and I will feel better. Its just words.
(5) People don't really care anyway!
Remember, not everyone is happy (far from it!) At least I am working on it, and I can get better. There is nothing wrong with me that cant be fixed with a good attitude.
Many people say they LIKE my eyes!
I have a lot to live for and I can be happy for the rest of my life. I am learning exposure.
Once I have passed the exposure treatment I will be able to do anything I want.
I can be happy regardless of what others think of me.
Be assertive and say NO! No-one can make you do anything you dont want to do!
It's not the end of the world if some people think I'm strange or thats somethings wrong with me. They have no way of knowing what its like to have panic attacks, so they couldn't really understand. This doesn't decrease my value or worth as a human being!
Be totally honest and telling the right people that sometimes you have panic attacks in public.
What was I telling myself that made me anxious? What was going through my mind? Change your thoughts and you’ll change the way the world appears.
To overgeneralise is to assume (falsely) that because you’ve had one bad experience in a particular situation, your bad experience will always repeat itself in similar situations.
Don't ignore the progress you've made when you inevitably have a setback.
Just because you feel ugly, doesn't mean you ARE ugly.
I feel therefore I am simply isn't accurate or true!
Just because it feels impossible doesn't mean that facing this situation is impossible.
“I should always be pleasing and cheerful to others, despite my feelings.” WRONG!
“I should be a perfect partner in a relationship.” WRONG!
“I should be totally self reliant.” WRONG!
“I should never get tired or sick.” WRONG!
I should, or I must statements are unreasonable if they are not flexible, inherited from your parents, not realistic, not life-enhancing.
Catch yourself in the act of engaging in negative self-talk. When you anticipate having to face a difficult task or phobic situation (worrying, overestimating, catastrophizing).
You may maintain your anxiety because you need to “keep everything under control”. Often your overestimating some danger or preparing for an imagined catastrophe - and so staying tense and vigilant is the way in which you give yourself a sense of control. However, in the process you can make yourself more and more tense, until you reach a point where your mind seems to race out of control and you dwell on danger and catastrophe almost to the exclusion of anything else!
The only way out of this vicious cycle is to let go and relax.
Take some deep abdominal breaths. Negative self talk is so automatic and subtle that is can escape detection if your not relaxed.
Find some form of distraction. Count down from 100 in your mind. Do something physical. Laugh or stamp your foot or shout (if your alone!)
Don't think :”I must worry about a problem before there is any chance it will go away!”
Also bad assumptions :”Im nothing unless I succeed” , “Im nothing unless others love and approve of me” .
Remember : “ITS OK TO SIMPLY BE MYSELF.”
Ask yourself :”What do I want from life? What could I do if I knew I would not fail!?”, "What would I do if money were no object?"
I want to be confident, a good sleeper, happy. I want to go places and meet people whenever I feel. I want to be a free spirit. I want that buzz back inside me. I want to do anything without needing a drink. TO SAY WHAT I BELIEVE TO PEOPLE. To not lie. To have adventures.
Write down the negative self talk or inner dialogue that led you to feel anxious.
Ask yourself what was I feeling? What thoughts were going through my mind to make me feel like this?
Remember: Self talk consists of thoughts, not feelings.
Identify the type of thought and look for any cognitive distortions that were present.
Mistaken Belief: ”Its very important to please others.”
Actually, it doesn't serve me to try and be pleasing when I’m actually feeling ill. I’ll be more honest and let people know what I’m feeling and ask for their support.
Its ok to not always be pleasing.
I can enjoy being pleasing at those times when I genuinely feel like it.
Mistaken Belief:”My accomplishments at work are extremely important.”
Actually, other areas of my life such as health, relationships, leisure time and hobbies are also just as important if not more! Learn how to balance work and play in your life.
AFFIRMATIONS:
(1) Circumstances are what they are, but I can choose my attitude towards them.
(2) I deserve the good things in life as much as anyone else.
(3) It's never too late to change, I am improving one step at a time.
(4) I am committed to overcoming my condition. I am working on it.
(5) If someone doesn’t return my love, I let it go and move on.
(6) I am learning that there is more to life than success. The greatest success is living well.
(7) I am learning to be honest with others, even when I don't feel like it.
(8) The world outside is a place to grow and have fun. The whole day is yours!
(9) I can replace worrying with constructive action.
(10) One step at a time, I can deal with the outside world. Dont project into the future.
(11) Some of us have steeper paths than others. That doesn't make me less valuable.
(12) Life is a school. Adversity develops strength and compassion.
(13) I can learn to cope better - with this and any difficulty life brings.
(14) I am mastering my anxiety and learning to let go of worry.
(15) When anxious thoughts come, I can focus on my breath and relax.
(16) When I see situations as they truly are, there is nothing to be afraid of.
(17) I am learning to control my mind and the thoughts I have.
Work on two affirmations at a time. Write it down repetitively, about 10 times a day. Say them out aloud with feeling and conviction.
Personality Styles That Perpetuate Anxiety:
(1) Perfectionism.
(2) Need for Approval.
(3) Need for Control.
Focus on positives: Think about what ways, small or large, you've been helpful or pleasant to people during the day. Think of any small steps you've taken toward achieving your goals. What other things got done?
In trying to please others, you ignore your own needs and feelings. Frequently you have a difficult time setting boundaries or saying no. You end up with a lot of withheld frustration and resentment over not having taken care of your own needs. Then you get anxious.
ATTITUDE ERRORS:
(1) If someone isn't friendly to me, it's because I did something wrong.
(2) Others’ criticism only serves to underscore the fact that I really am unworthy.
(3) I think I'm a nice person. Shouldn't everyone like me?
(4) Others’ approval and acceptance of me is very important.
An inability to handle criticism is a bad sign.
Codependency is the tendency to put others needs before your own. It will make you stressed, tired and eventually physically ill.
You have a right to be unpleasant or do things that other people may be angry about. Fear of other peoples anger should not influence what you want to say or do.
Its OK to ask for what you want from others.
Its OK to say no to others demands when you need to.
The excessive need for control makes you want to have everything in your life predictable. It's the opposite of letting go.
It happens after a trauma in your life and it makes you defensive and vigilant.
However you must learn to accept that some things are beyond your control, such as other people. Learn to let go, and go with the changes. Just say “That's the way it goes.”
Learn to take life as it comes, let go and let things work out, relax and tolerate a little disorder, don't take yourself or life too seriously.
Be patient. Don't strive to find peace, let peace come to you. Wait for answers to emerge.
When you look back over problems you had in your life, you will see that the problems eventually worked themselves out.
Visualization:
It has been demonstrated that any type of performance can be improved through repeatedly visualizing success.
Make copy of page. 234.
Expressing your Feelings:
Feelings are what give you energy. If you are in touch with your feelings and can express them, you will feel more energetic. Withheld feelings can lead to ANXIETY.
Phobic and anxiety-prone individuals are susceptible to taking on the feelings of people around them. The more comfortable you are with your own feelings, the less this will occur.
Your ability to gain awareness of and express your feelings is an essential part of the process of recovering from anxiety disorders.
If you experience tightness in your back or shoulders or your stomach, this may indicate you have been withholding strong feelings.
Ask yourself “What am I feeling right now?” or “What is my main worry right now?”
Once you identify what you are feeling, then you must “let them out” by
(1) Share them with someone else. Be sure they are willing to listen. Refrain from blaming anyone. Start sentences with “I feel…” Refer to the other persons behaviour without making a personal attack. They can see its something they can easily change.
(2) Writing them out.
(3) Physically discharging them. Bashing or screaming into a pillow. Do not dump your anger on someone else. Try shouting in your car.
Work on overcoming fears about alienating people you care about when you allow your anger to emerge.
If anxiety plays too big a part in your life, take that as a sign that your’re denying yourself some of your basic needs.
Asserting Oneself:
With your partner and others, you often end up doing many things you don't really want to do. This creates resentment, which in turn produces tension and sometimes conflict. You may be surprised when you begin to get more of what you want as a result of asserting yourself. You will also get increased respect from others!
Anxiety prone individuals are often submissive, because they are overly invested in being nice or pleasing to everybody. Or they are afraid that the open expression of their needs will alienate a partner on whom they feel dependent.
While communicating assertively, do not back off or move away from the other person. Literally stand your ground.
Print out PERSONAL BILL OF RIGHTS. p.258.
Be sure not to assume that other people already know what you want : you have to make your needs known. Things to say (don't apologise):
“Im feeling upset right now and I would like you to listen to me.”
“I feel angry when you don't listen to me.”
“I feel very sad and unloved when you don't seem to be helping me in my attempt to get better.”
“I would like you to take the dog out for a walk tonight.”
“If you keep talking to me like this, I'm going to leave. We'll talk again tomorrow.”
“If you respect my need to have some quiet time, Ill be much better able to spend some time with you afterwards and to be a good companion.”
“I realize you would like to go out with me again. I think you're a fine person, but it seems to me that we don't have enough in common to pursue a relationship, so I have to say no.”
Self-Esteem:
It is dependent on recognizing and taking care of all of your needs. Print off p.295
Nutrition:
Certain foods and substances tend to create additional stress and anxiety, while others promote a calmer and steadier mood.
Smokers tend to be more anxious than non-smokers.
The following habits can aggravate your daily levels of stress:
(1) Eating too fast.
(2) Not chewing food at least 10 times per mouthful.
(3) Drinking too much fluid with the meal. One cup is sufficient.
Avoid fruit juices or dilute them 1:1 with water.
Have some nuts around 4 in the afternoon. If you awaken early in the morning at four or five, you may find that a small snack of nuts will help you get back to sleep for a couple of hours.
When you have come off benzos try KAVA: A relaxing herb. I would recommend that you not use kava on a daily basis for more than 6 months. However intermittently it can be used forever.
Valerian has a good reputation for promoting sleep. Numerous studies have shown that it can reduce the time it takes to sleep and improve the quality. Don't use it for more than 6 months at a time though and DO NOT mix it with benzos. It can be mixed with Kava.
If you are taking an SSRI or benzo do not try natural supplements without talking to a doctor first.
Try carrot juice.
Depression is associated with early morning awakening.
In the last two hours of the day wind down with soothing TV programs or reading.
If you cannot sleep after 30 mins get up and read on the sofa until you feel sleepy again.
A small healthy snack just before bedtime can be helpful.
Dont have long naps during the day.
Low doses (0.25-0.5mg) of Rivotril may help you with exposure to your phobias.
Dealing with sexual side effects of medicine:
(1) Reduce the dose of your SSRI by half on days you will be sexually active.
(2) Take 5 to 10mg per day of BuSpar alone with your SSRI.
(3) Taking cyproheptadine with your SSRI.
(4) Trying DHEA suppplements of 25 to 50mg a day.
Benzos:
The higher the dose (more than 1mg) and the longer you take them (more than 1 month), the more likely you are to become physically dependent. This may mean that stopping the medication abruptly will cause SEVERE anxiety symptoms. A more gradual tapering of the dose over MONTHS is what makes withdrawal possible.
The problems with Benzos is that your anxiety will return 100% when you stop taking them unless you have learned coping skills in the meantime. Breathing, relaxation, stress management, working with self-talk, exposure, etc.
Please come to regard your condition as an opportunity to grow and expand who you are.
Some conditions are so challenging that they compel us to let go. There is no alternative.
Use your free time to do what you want to do. Express your creative gifts and give your life meaning.
Connecting with your “Higher Power”:
(1) Get comfortable in a seated or lying down position.
(2) Bring to mind the situation or person that you are anxious or worried about.
(3) Affirm over and over with conviction: “I turn this over to my Higher Power. I release this problem to my Higher Power.”
Print off p.421, p.422, p.424 of the workbook.
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