Be Calm
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ISBN: Print 978-1-64152-208-3 | eBook 978-1-64152-209-0
peace for all
Contents
Quick-Start Guide
Chapter One: Is Anxiety Running Your Life?
Section I: Feelings
Chapter Two: Your Emotions
Chapter Three: Your Body & Physical Sensations
Chapter Four: Putting the Tools to Work
Section II: Behavior
Chapter Five: Avoidance & Escape
Chapter Six: Acceptance & Approach
Chapter Seven: Putting the Tools to Work
Section III: Thoughts
Chapter Eight: Thoughts vs. Reality
Chapter Nine: Getting Unstuck from Thoughts
Chapter Ten: Putting the Tools to Work
Section IV: Staying on Track
Chapter Eleven: The Road Ahead
Chapter Twelve: Building Your Support Network
Resources
References
About the Author
Quick-Start Guide
This book provides a variety of strategies and techniques that have proven effective at reducing anxiety and its most troubling symptoms. Any of the strategies you choose to practice will help your anxiety overall, but I’ve divided them up here based on which type of symptom they target. This Quick-Start Guide will navigate you straight to the set of strategies that will help you deal with acute symptom flare-ups and anxiety-producing situations.
Section I: Feelings
Turn to the strategies starting here if you’re feeling strong emotional or physical symptoms of anxiety.
•Anger/irritability
•Sadness
•Hopelessness/despair
•Insomnia
•Mood swings
•Racing heart
•Shortness of breath
•Dizziness
•Stomach upset
Section II: Behavior
Turn here if your anxiety is making you behave in ways that you don’t like or that are causing you problems. Section II will be helpful when your anxiety causes you to:
•Avoid activities you used to enjoy
•Avoid certain people
•Frequently cancel plans
•Call in sick to avoid stressful events like presentations
•Feel unable to do routine things like drive or go to the store
•Behave uncharacteristically in anxiety-provoking situations, e.g., you don’t approach or talk to your friends when you’re at a party
Section III: Thoughts
Starting here, you’ll find strategies to help diminish the inaccurate or unhelpful thinking that preoccupies the mind when you’re caught up in anxiety. These thought-focused strategies will help if you’re experiencing:
•Chronic worry
•Repetitive or racing thoughts
•Catastrophic (worst-case scenario) thinking
•Self-defeating thoughts (e.g., “I suck at this, so I might as well give up.”)
•Irrational beliefs (e.g., “If I don’t drive back home to check the oven, my house will burn down.”)
Welcome
Everyone feels anxious at some point! I have worked with anxious clients for the past 15 years in my practice as a clinical psychologist. Some come to me believing that their anxious feelings can improve. Others enter therapy reluctantly, mostly convinced that nothing will ever reduce their panic symptoms, avoidance behavior, or worried thoughts. People who improve typically have two things in common:
1.A part of them, no matter how small, believes they can get better.
2.They learn, and put to work, effective anxiety-reducing strategies.
Simply opening this book and reading this far shows that some part of you believes your anxious symptoms can get better. And if you’re willing to engage with this material and give serious thought to the impact anxiety has on your life, there’s a part of you that wants to get better. Take heart; you already have all you need to start managing your anxiety symptoms and living a happier, more fulfilling life.
How to Use This Book
Psychology is a young science, and there’s still quite a bit we don’t know. However, we do know how to treat anxiety. Most people who consistently use the psychological tools in this book will find relief. My clients who use these methods tell me that although they are still aware of their worried thoughts, those thoughts no longer have the same power over them. So instead of feeling as if the waves in the ocean are pulling them under and they have to fight for dear life, they realize they can float—even in a stormy sea. They ride out the tempest by using their tools and knowing that the waves will eventually subside and the sea will be calm again.
The strategies in this book are simple to implement. They are all evidence based, meaning research has proven their effectiveness. They come from cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT, pronounced like the word act), and mindfulness practices.
It’s not necessary to go through the book from start to finish in order to improve. You likely have not experienced the whole range of possible anxiety symptoms described here, so you may choose to skip some sections, depending on what you’re experiencing. A
lthough this is not a workbook, it is full of practical strategies and instructions for how to implement them. In each of the nine main chapters you’ll see sections titled “Go Deeper,” which are suggestions on how to take the strategies to the next level. (You’ll need a notebook or journal for these.) The “Go Deeper” strategies are optional, but they are a great way to maximize your results.
A NOTE TO READERS: The clients in the examples used throughout the book are composites, and the names are fictional to protect anonymity.
Getting Started
Keep a notebook or journal handy so you can jot down your thoughts about the strategies as you try them out. Your notes will help you reflect on what you’re learning and how your new skills can help you better cope with anxiety. The more you practice and write about the strategies, the faster they’ll become automatic responses to your anxiety triggers.
Once you have your notebook and are ready to start, take a moment to think about your schedule. Consider how/when you want to work on this material and when you can best fit it into your general routine. To really get up to speed with your new skills, daily practice is the way to go—even if you can set aside only a few minutes. The point is, give some thought to how you’re going to integrate this book into your routine.
If you’re in the middle of an acute symptom flare-up, I encourage you to go directly to the relevant section. So, for example, if you’re consumed by worried or intrusive thinking, start with section III, “Thoughts”. If your anxiety is causing you to avoid important events or people, you may want to start with section II, “Behavior”. If you’re struggling with your feelings or physical health, start with section I.
To reach longer-term goals of sustained peace of mind and inner calm, consider breaking the material down into small, doable steps so you eventually work through the entire book, at the pace that suits your life.
CHAPTER ONE
Is Anxiety Running Your Life?
Why We Struggle with Anxiety
A snake on a hiking trail, or a gun in your face, or any direct threat to your well-being will trigger your fight-or-flight response. When this happens, the sympathetic nervous system releases a cascade of hormones, in particular adrenaline and epinephrine. These stress hormones very rapidly cause a series of changes in your body, including increased blood pressure and heart rate, slowed digestion, tunnel vision, shaking, and increased muscle tension. All this prepares you for a full-throttle physical response to the danger. These changes come together in an instant, to create a singular focus on survival.
When anxiety is appropriate—as in the case of the snake or the gun—this physiological response is normal, because it prepares us to respond to the potential threat. Even when the perceived danger isn’t life-threatening, anxiety can still be helpful. For example, a student might need to achieve a certain score on a test in order to be accepted to medical school. His anxiety motivates him to study, take a test prep course, and spend considerable time on practice exams. The fear of failure can energize and focus him for the hard work ahead. Or a person driving on a busy highway suddenly experiences increased heart rate and blood flow when she sees someone screech to a halt in the lane next to her. The immediate increase in heart rate prepares her for action, so she can steer toward safety if she needs to. These kinds of anxiety responses may not be saving our lives, but they are adaptive and keep things running smoothly.
Anxiety becomes a problem when a person’s fight-or-flight response is triggered by cues that are not threatening at all—either physically or otherwise. For instance, the person who obsessively worries about their health even though tests have ruled out a medical condition. This person is unable to be present with the people around them because they’re constantly preoccupied by what might or might not be going on medically. Or take the person who fears using public bathrooms and eventually avoids all business travel in order to not have to confront this fear. If travel is necessary for work, this person’s career will be limited or ended by what is, at its core, an irrational fear.
Anxiety isn’t just a problem of overreacting to things happening around us; our anxiety response can be triggered by things that exist only in our minds. This happens when we worry about and anticipate what-ifs and worst-case scenarios, which may never come to be. Consider the person who feels insecure and frets relentlessly about the possibility of doing something wrong socially and being embarrassed. Eventually their social world becomes smaller and smaller. They may no longer go to social events and may even stop opening up to people they’ve known for a long time.
If you’re holding this book, you likely struggle with anxiety in some way. But you may still have questions about whether or not anxiety is a problem for you, or about how serious a problem it is. There are some general ways to assess if you’re dealing with problematic anxiety, or just the normal fears that arise in life from time to time.
Anxiety is adaptive when it comes in response to an in-the-moment fear of risk in your immediate environment. Anxiety is maladaptive when it becomes a chronic state of tension, worry, and/or avoidance behavior, all of which negatively impacts your life and functioning.
The table below describes the differences between normal fear and problematic anxiety.
FEAR ANXIETY
Fear is present-focused and generally rational in that it’s responding to a threatening situation or event. Anxiety is future-focused and can easily become irrational because it is untethered from real events. Your imagination continually calls up what-if scenarios.
You’re in the here and now. There is a fire in the house, and you’re figuring out how to put it out. Once the fire is out, your fear subsides. You feel worry and discomfort even though you are not in immediate danger. No clear threat is present and there is no clear way to solve the concern.
Fear comes from real threats in the outside world, e.g., job loss; medical diagnosis; illness of a loved one; threat of being physically harmed; wanting to do well on a specific task, such as a speech or an exam; wanting to make a good impression on new acquaintances. For the most part, anxiety isn’t created by the outside world; it’s created by your mind. You worry about possibilities that may or may not happen, such as: “What if they don’t like me?” “What if the plane crashes?” “What if I can’t leave the movie theater?” “What if they hate me?” “What if I have a panic attack?” “What if I make a fool of myself?”
What We Can Do About It
The Anxiety and Depression Association of America estimates that 40 million people suffer from anxiety disorders, which are the most common issues that bring people to therapy. Thanks to decades of research, we know a good deal about how to treat them. In fact, anxiety symptoms of all kinds are very responsive to treatment, offering anxiety sufferers long-term relief. This book gives you access to some of the same tools I use in my practice to help people struggling with all types of anxiety symptoms.
The techniques in this book are taken mainly from three scientifically tested and proven-effective interventions. As a clinician and also as someone who struggles with anxiety, I have personally found relief using these specific approaches, and so have my clients. I believe you will, too.
What research and experience have shown me is that a combined approach of examining your thoughts, accepting (not necessarily liking!) anxiety as a part of your life, and learning to be more present in the here and now are the essential keys to reducing anxiety and living a more peaceful life.
Having anxious thoughts becomes a self-perpetuating cycle that creates more anxiety. We’ll use cognitive behavioral therapy to examine and change your thoughts. Strategies from acceptance and commitment therapy will help you behave in a manner, and ultimately live a life, that matches your core values and desires, regardless of your mood or anxious symptoms.
As you grow to accept that we all suffer sometimes, you’ll find there’s more room for you to separate from your battle with anxiety. Through practicing the mindfulness strategies throughout each chap
ter, you’ll be more easily able to bring your thoughts back to the here and now. As you learn ways to observe and distance yourself, even if only slightly, from your anxious experiences, you will be less overwhelmed and more able to experience joy and pleasure in your life now.
Habits and Neuroplasticity
Struggling with anxiety can be so demoralizing that we give up. Similar to traits like height or eye color, people who struggle with anxiety can start to believe that they were born anxious and there’s nothing they can do about it. However, the reality is that changes in our environment, along with learning new skills, have a significant impact on anxiety and can lessen anxious symptoms over time.
Neuroscience shows that neuronal growth and structural changes in the brain occur as the result of new experiences, and also as the result of how you think and behave. A real-life example of this would be if you decided you wanted to change your habit of snacking right before bed. Perhaps you’ve eaten chips or crackers before bed for years, and you decide to substitute sliced vegetables. The plan is solid and you’re ready to go. However, you’re unlikely to be successful in changing this habit if you substitute your chips for veggies only once a week or every couple of weeks. On the other hand, if you consistently eat sliced veggies every night of the week, or even just most nights of the week, your brain will adjust and the new habit will take hold.
When you repeat a new behavior enough (which continually fires the same neuronal pathway), the new experience becomes a part of your brain’s system on a chemical level. This phenomenon is called neuronal plasticity, or sometimes brain plasticity.
SELF-ASSESSMENT
Tap Your Growth Potential
People just like you, with similar symptoms and levels of anxiety, have triumphed over anxiety largely because they believed they could. Recognize if you send yourself self-defeating messages, such as telling yourself no amount of work will lessen your symptoms. Just having these thoughts can hinder your progress.
Take this assessment to see how much you believe in your ability to grow and have the internal peace you deserve and desire. If you answer yes often, let’s plan to cultivate your capacity to believe that freedom from anxiety is possible.