(Obsessions are dealt with in the cognitive part of CBT - see Part Three.)

Once you have worked through this book you will have the skills you need to prevent relapses. And do you think that having Anxiety is all your own fault? In Apdix 2 you will find contact details for the professional bodies that regulate some of the complementary and alternative therapies available, which may be helpful in treating anxiety disorders or relieving symptoms. If it is the upper hand, the one on your chest, then you are breathing in a shallow way that isnt helpful for Anxiety. I tell myself I can only do so much. Here is an example from someone with severe agoraphobia: Physical: sick and shaky, lightheaded. Many people who are required to perform as part of their profession - actors, musicians, teachers, politicians - suffer in this way before a public appearance. I just want to be alright - can you define alright? Its the same with life experiences: if a parent dies or leaves you when you are young you may develop your own core belief that people always abandon me. As human beings we want to do more than just survive and raise our children in safety. Lets look at three very common ones: Scanning or hyper-vigilance This means watching yourself all the time for alarming bodily sensations. Anxiety/Panic Disorder This is the form of the disorder that brings on sudden attacks that paralyze you with fear for no apparent reason. If you can't lay down, sit still, close your eyes and focus on slow, even, breathing. So if you are brought up by your parents to believe that boys dont cry or if in your culture girls are second class citizens then youll find it hard to resist that conditioning. Wouldnt you like to wrest that control out of Anxietys hands? What this means is that, in 'layman's terms', if you suffer from Anxiety Disorder, or any form of it, that you will be confronted with paralyzing fear for no apparent reason that will make you feel as if there is no possible way out of it. All Anxiety is driven by the thoughts that go round and round in your head, but with OCD there is an extra element because the thoughts link in to beliefs, usually about preventing harm. Sit quietly and feel how the hands move as you breathe. Goals might include meeting friends, going to public places, doing voluntary work or doing a sport or social activity. Be honest with yourself, no one else needs to know about it.

You lack assertiveness if you: Feel unable to speak up.

Contradict your if only. It keeps me from taking on risky challenges because I know Ill fail at them. No energy feeling guilty, feeling worthless, blaming yourself taking no pleasure or interest in your usual activities problems with memory or concentration changes in appetite and sleeping pattern withdrawal from people and social activities restlessness irritability and anger feeling pessimistic and hopeless thinking about death, or contemplating suicide. In England we dont have many thunder-storms so I got a tape of a thunderstorm from First Steps to Freedom. After all, you pulled through it before so there is no reason why you shouldnt pull through it again this time. Your physical and mental abilities are not damaged by your anxiety illness and you will always be capable of coping with an emergency. I feel like I was living in a different world to everyone else. One day you will achieve them. However, not every person who has experienced an Anxiety attack will develop a full blown disorder, but don't discount the fact that potentially they COULD. Bills piling up, children seemingly out of control, pressure from work, family, and other events can trigger this disorder bringing it to the surface of an otherwise “dormant” carrier of the genetic traits passed on by their parents. Each ladder has to be individually tailored. Anxiety has let you off that particular hook. Repeat each step until you are comfortable with it. The next step is to give points out of 10 for each of the items on the list for the two holidays, as follows: At this point there isnt much to choose between them. Even people who have made good progress in their recovery sometimes feel disappointed in what their new life has to offer them. When you read about the need for change, did you feel a stab of fear? People with OCD do often admit to their difficulties, because they need help with their OCD. Youll then be able to create your own individual recovery programme. It is fuelled by a sudden release of adrenalin into the body. I havent had a Valium since 198 Anxiety Disorders This is a brief overview so dont worry if your particular phobia or obsession isnt mentioned here. Breathe quietly, and focus on the word relax. If you are using an exercise video or DVD, try to find one that is not too challenging.

The mints were the last to go as I used to get a very dry mouth (I had sugar-free mints so that I didnt get a sugar rush). My main coping skills are relaxation, and meditation, which stops the internal chatter. My coping skills are: controlling my breathing, regular exercise, music (I put on headphones and block out anxious thoughts), making myself socialize even when I feel I cant be bothered and asking for support from friends. My main coping skill was using my bike - you can always escape and come back quicker. After reading this section you should understand how to do exposure work to change your Anxiety driven behaviour in small, manageable steps.

Instead look for ways of reducing the amount of time you sd with them, or reducing the number of times you need to do them. Dont, whatever you do, belittle your achievements. Make your own list of five goals in your notebook. Except it was always going to stop whatever you did - fight-or-flight is a short term reaction remember. Many of these are automatic and arise so quickly that we are hardly aware of them. Not bothered/fairly unhappy/find it unbearable Are you ready to face up to what needs to be done? Breathe out. Emotional: as well as the dominant emotion of fear you may also feel shame and lack of self-worth. Even going on holiday or preparing for Christmas can involve a measure of anxiety. Id tell them not to be so hard on themselves. Never mind. In England we dont have many thunder-storms so I got a tape of a thunderstorm from First Steps to Freedom. The surge causes physical sensations that increase dramatically as the attack progresses. Your helper If your helper has read Chapter 25 they already understand what they can do to help you. The trouble is, deep down, you will still be afraid of having another panic attack. You believe that the behaviours are holding Anxiety in check, but in fact you never get to test that out. Without warning. There are also sleep disorders, such as sleep apnoea, which need medical help. This will help you to feel confident and motivated to work on your thoughts. Whatever you do, dont give up.

There is no difficulty in understanding the effects of negative core beliefs - they undermine your self-esteem and sense of self-worth.

Write down in your notebook exactly what you intend to do, and what you expect the outcome to be for each of the two theories: Example: Test: I wont do my cleaning ritual in the living room for one day. Recognising when weve been victimised helps us to deal with the bad experience, and reminds us to nurture ourselves when its over. Its important to understand that escaping does not make Anxiety go away. Or did you try to take too big a step, and instead of moving up, you lost your footing and slipped back down? Unfortunately someone with Anxiety is most likely to have negative core beliefs, for instance: Im not lovable other people always let you down life isnt fair. I am still extremely scared to go to places associated with where it haped. School was terrifying, I was so self-conscious. They dont need to understand the nature of Anxiety disorders, as long as they can accept that you need to do exposure in a certain way. If this is the case for you, we recommend that you look for professional help from a counsellor or psychotherapist. Where the script says hold it, you should maintain the tension in that muscle for a few seconds. Instead try to work out if there were any special circumstances that might have caused the setback. This doesnt have to be a full breakfast, but once you are fully awake it is good to eat breakfast - it will give you energy for the next few hours. Hold it and really squeeze your lips together. Also you can collect evidence to test the truth or otherwise of your beliefs. In fact what she didnt know was that the receptionist had broken her glasses, and was struggling through the day without them. We all still have, inside us, the child that we used to be - spontaneous, creative, playful, fearful and insecure. How far and how long varies, according to how severe your agoraphobia is. Let your breathing be slow and calm again. Catching a glimpse of the cooker may set off thoughts about checking the gas, or walking towards a restaurant may set off the thoughts that lead to a panic attack, but the first thing you may normally be aware of is the adrenalin surge of Anxiety. Is there really any risk of danger? Distraction techniques.

You may start wonderfully, going off like a rocket, and then grind to a halt.

Travelling by bus Take the bus for one stop, at a quiet time, sitting near the door with helper beside you. You can face life anew. In the Gains column list all the benefits from taking the risk, and in the Losses column list every disadvantage of taking the risk. I will look through my notebook and see how many good days I had, because they are just as important. At first your Anxiety may well send nagging thoughts (just like a child in a car repeating are we nearly there yet? endlessly) but all you need to do is give your chosen response and keep on with your planned session. Something as simple as patting your pocket, or looking in your bag, tells any onlooker that youve forgotten something and explains why youve turned back. The extra oxygen that you are taking in is being rushed to your muscles to pump them up ready for action. Dont let yourself slide back into the hopeless black hole. Do exposure frequently, at least once a day. ABOUT CAFFEINE Ive never felt that caffeine was a factor in my anxiety - I have tried cutting down and it made no difference, although I am aware of the effects if I have too much coffee. I gave up caffeine and it helped me quite a lot. I know I drink too much coffee. Will my heart stop beating? They must do - they wouldnt run helplines just for me. Ill never find someone to love me. All-or-nothing thinking I got one thing wrong and that ruined everything. Everything else was OK, so I did pretty well. People with this disorder often think of themselves as ugly or disfigured, and have problems controlling negative thoughts about their appearance, even when reassured by others that they look fine and that the minor or perceived flaws arent noticeable or excessive. Keeping a diary was a great idea, because I felt obliged to tell the truth in it, and the only way I could record improvements in the diary was by doing the work and making the improvements. . My mother worried but she kept it all inside her, I never knew till later on when I was caring for her. Changing negative core beliefs is a slow process but worth the effort. They dont need to understand the nature of Anxiety disorders, as long as they can accept that you need to do exposure in a certain way. You must understand that your helper isnt a saint - just someone who is trying to do their best for you. If you have depression, whatever has caused it, you will have to decide whether to work on the depression before you turn your attention to your Anxiety.

use your life experiences to teach yourself to be happy.

Now bend your arms at the elbows. What will hap next? Automatically they think its panic - what if I cant handle it? Their underlying assumption causes them to think I should be able to handle it. Their core belief causes them to think Im useless, I cant handle it, I need to get out. They then leave the situation because they believe they cant handle the panic. Ill start with loving myself. This just means increasing the score of important items by multiplying them by a chosen number. Do bear in mind that you need to feel some Anxiety while you are doing your exposure. You dont have to make a precise record of quantities, because this isnt a weight loss, or weight gain, exercise. Next, push your tongue up against the roof of your mouth. But the story isnt finished yet. I also tell myself how much time I can sd on something, and that helps me to stop and walk away from it. Its easy for any of us to develop the habit of using the expression what if? This is where we need to change our habits and replace this expression with the words so what! Consider the following question. Another approach is to set aside times for worrying: Worrying allowed on the hour, every hour, for ten minutes. If youve had a panic attack in a crowded bus, you will associate crowded buses with panic and start to dread getting on the bus if it looks full. You can eat the kind of food you like. Sometimes all that is needed is a little input from someone who understands, and there are charities that offer mentoring schemes for people with Anxiety disorders. Id tell them we all have problems from time to time and Id tell them not to worry about the teachers reaction, teachers are tough types who arent easily thrown. It was difficult to put my feelings into words and that sent my anxiety up. Even the smallest progress counts, even the fact of having a go at recovery counts, and even the worst case of Anxiety ever can get better. Someone calls an ambulance, they are taken to Accident and Emergency, and after the usual tests they are told that its panic. The extra oxygen that you are taking in is being rushed to your muscles to pump them up ready for action. Several of them are volunteers with charities such as No Panic and First Steps to Freedom.

Typical thoughts are: I wont do my exposure today because I dont feel like it. I feel useless, so that means I am useless. Jumping to conclusions This means making decisions about other people - what they meant when they said a certain thing, why they did a certain thing, what they were thinking when they glanced across at you and so on.

Coming off tranquillisers and anti-depressants If you have been prescribed drugs for Anxiety, especially if you have been taking them for some time, you may wish to give them up. Now repeat your goal - because you have done it before your physical Anxiety will be lower, and you will be able to pay attention to your thoughts. My advice for anyone with General Anxiety is - use positive thinking, and alleviate your anxiety by living well and looking after yourself. The best advice I can give to anyone who thinks they have tried everything and nothing has worked is: be prepared to go round the loop again. Work out why bedtime causes arguments, and try to make it more enjoyable. Doesnt that take some courage? Unfortunately it wears off just as quickly, leaving you down in the dumps again. There will be more change as you work through this book. Not a nice feeling I'm sure you'll agree. Critic Im a useless parent. There are three possibilities: They may decide that youre just shy, or guess that theres some sort of problem. The problem with this is that pretty soon youve got a whole list of things that you cant do, life becomes a misery and you still suffer from Anxiety. Of course its true that many people alive today do not have the luxury of worrying about their self-esteem, or their core beliefs, because they are entirely focused on survival - enough to eat, a future for their children. More severe depression will need help from your doctor, in the form of anti-depressant tablets or visits to a counsellor. Building confidence and self-esteem All of the work you have already done will help you build your self- confidence, in particular: Improving physical fitness. We dont mind if you get angry with us - anger gives you energy, just what you need right now. This thing can be conquered, its not just for the few. Wishful thinking By whose standards are you judging yourself? Exercising helps with my sleeping. I wake up if Im anxious.Positive Experiences Anxiety sucks all the pleasure out of life. Arch your back slightly and clench your buttocks.

I was unsteady on my legs and would often feel as if I was going to fall through the ground.

But still, undertaking the programme will feel risky. You need to weigh up whether they are helping against the disadvantages. You can start by cutting down on the number of times you repeat a compulsion, or by increasing the time between exposure and starting the ritual. However, not all the factors are of equal importance, and you can reflect this by weighting each item. YES/NO Youll become self- protective and afraid to take on anything new in case it makes your Anxiety worse. I still monitor my breathing on bad days and now its much slower! Ive worked on my breathing - the hospital taught me to blow bubbles. What about if youre disappointed? It mustnt feed into your Anxiety (such as saying a prayer if you have compulsive thoughts around prayer). Dont ever just stop taking them. Oh no! Always make goals small enough that you have a good chance of succeeding. Ask yourself how much you believe it to be true, and how important that is. While you may BELIEVE this to be true because you have never yourself experienced the unrelenting terror of an Anxiety attack, that doesn't mean that it isn't happening to someone you care about. Another good technique is to work with another person and ask them to repeat your counter statement to you, while you return the favour and repeat their counter to them. Sometimes its entirely appropriate to do this, for instance in the area of personal relationships. If you were discouraged from expressing them you might, over time, reach a point of deliberately avoiding these feelings. I am now trying to find healthier, more positive outlets. Ive always eaten well, when I was on Valium I didnt put on any weight at all, I was constantly hungry but I was underweight. More about Diet Understanding the effects of caffeine Caffeine is a mild stimulant that raises your heart rate and creates a short-lived burst of energy. The speed of breathing isnt important; what helps me is the awareness of the rhythm of my breathing. I know that I breathe badly when Im tense, I need to work on that.I learnt how to control my breathing and Ive found this really helpful. Wishful thinking By whose standards are you judging yourself?

All that we are is the result of what we have thought.

Practise letting go of the importance of the obsession - see it as background noise that can be ignored. It can also be difficult to identify the external trigger that sets off the thoughts. Next, they look at the Losses list and decide whether they can manage the risks: I might not enjoy the film - I can cope with that. Your eating pattern How does your eating pattern compare with the model? You will need a lighted candle - be careful with it. If you are prepared for them, they wont overwhelm you or send you hurrying back to your safe retreat. Standing in a queue, e.g. at a supermarket checkout or in a bank. What are the alternative ways of approaching this? Your body is very keen to switch off the fight-or-flight and with a little help from you, it will manage it. Many anxious people have an underlying fear of losing control, even for a moment (which explains why some people find it so difficult to accept the need for relaxation). In most documented cases of Anxiety attacks, the patient rarely reports any event that would have triggered the onset of the attack itself. Relax and feel the difference. Only you can decide what is right for you, but many people have reported the great relief they felt when they finally confided in someone. This is so that you can learn to trust this type of breathing. If you are nervous about doing this, consider taking someone sympathetic along with you for support. Youll become self- protective and afraid to take on anything new in case it makes your Anxiety worse. It usually isnt so bad, so Im learning not to always expect the worst. I was getting more and more agitated but we did get the volume very high and the thunder sounded very real - this triggered a massive panic attack and we had to stop. If that is the case, take it more slowly and be prepared to work harder on it. Another aspect of this is the person who does not learn to contain their emotions and will be unable to tolerate any upset or frustration in their adult life.

Any kind of personal confrontation.

And yet they might well have simply not seen you, or been sunk into their own thoughts and worries. The techniques we describe will still work for you. I have since learnt that this type of treatment is called exposure therapy where your fears are faced head on. Your own reactions are of overwhelming importance to you but by focusing on them so much you can lose sight of other ways of viewing a situation. While the above examples are extreme, sometimes, to an Anxiety sufferer, it absolutely feels like the end of their world. Do you sleep less after a bad day for Anxiety, or does the exhaustion mean that you sleep more? I go jogging and go to the gym, walk, cycle. Here is a reminder checklist: & overestimating the chances of danger & overestimating the size of the danger & underestimating your ability to cope with the danger & scanning & fear of fear & self-fulfilling prophecies & worrier & critic & victim & perfectionist & overestimating a bad outcome & catastrophising & unrealistic expectations & all-or-nothing thinking & over-generalising & filtering & discounting the positive & magnifying/minimising & emotional reasoning & jumping to conclusions & taking it personally & blaming yourself & name calling & wishful thinking. Start by answering these questions. If you approach this with an o mind, and accept the possibility of change, you have every chance of success. The only answer is to take the issues one at a time, and the key at all levels of goal setting is to start with the one that you feel will cause you the least stress and be the easiest to achieve. This was the first of many, in adult and adolescent units in different parts of the country, following suicide attempts and episodes of self- harm (cutting, burning, solvent abuse, periods of dehydration (self- inflicted) and also periods of starvation.) Someone with OCD may also come to believe that just by having the thoughts they can cause bad things to hap. In the quest to be perfect someone with OCD can blame themselves for any thoughts they have which they judge to be bad thoughts and may feel they should be punished for having those thoughts. Discounting the positive I cut down my checking yesterday morning, but I was as bad as ever in the afternoon. Also, no one likes to waste food, and yet for someone who is struggling a whole banana or a whole slice of toast can seem just too much. No. Think back over your life in the two years leading up to your first experience of panic, phobia, obsession or GAD and tick any of the items that you experienced. If they have a fear of doing their rituals in public, they need to cut down on their rituals. Blaming yourself Do you feel responsible for everything that haps to your nearest and dearest?