Welcome!

This section contains information on how to manage anxiety in general as well as information and management strategies specific to several disorders. There is a lot of information in this section so remember you can always come back and learn more.

You may also find these strategies most helpful while undergoing therapy.

Do you have mild to moderate anxiety?

If you have mild to moderate anxiety, click here to learn more general strategies for managing your anxiety at home.

Do you have a diagnosed (or suspected) anxiety-related disorder?

Click here for a list of 7 disorders and subtypes. Click on each disorder for a more detailed description (including a video and stories) as well as self-help strategies that are specific to that disorder.

Most people do not recognize their anxiety for what it is and instead think something is “wrong” with them. Some people are preoccupied with the symptoms of anxiety (e.g. stomach aches, increased heart rate, shortness of breath, etc.). Others think they are weird, weak or even going crazy. Unfortunately, these thoughts only make people feel even more anxious and self-conscious.

Therefore, the first step to successfully managing anxiety is to learn to understand and recognize it. Self-awareness is essential.

The Facts

Myth: Reading, thinking and learning about anxiety will make you even MORE anxious.
Fact: If you do not know what you are dealing with, how do you manage it? Having accurate information about anxiety can reduce confusion, fear and shame. Anxiety is a common and normal experience, and it CAN be managed successfully.

Learning the Facts About Anxiety

1. Anxiety is normal. Everyone experiences anxiety at times. For example, it is normal to feel anxious on a rollercoaster or before a job interview.

2. Anxiety is adaptive. It is a system in our body that helps us to deal with real danger (for example, anxiety allows us to jump out of the way of a speeding car) or to perform at our best (for example, it motivates us to prepare for a big presentation). When you experience anxiety, your body’s “fight-flight-freeze” response (also called the “adrenaline response”) is triggered. This prepares your body to defend itself.

More on Fight-Flight-Freeze
Our body’s natural alarm system (the fight-flight-freeze response) can be activated when there is a real danger, such as coming across a bear when hiking in the woods. In this case, you may flee (e.g. run away from the bear), freeze (e.g. stay still until the bear passes), or fight (e.g. yell and wave your arms to appear big and scary).

This response can also occur when something feels dangerous but really isn’t, such as being interviewed for a job. For example, you may feel jittery, on edge or uncomfortable. You may snap at people (fight) or have a hard time thinking clearly (freeze). These feelings can become overwhelming and make you feel you want to avoid doing the interview (flight). Many people stop doing things or going places that make them feel anxious.

Can you think some ways you may fight, flight or freeze because of your anxiety?

3. Anxiety is not dangerous. Although anxiety may feel uncomfortable, it is not dangerous or harmful to you. Remember, all the sensations you feel when you are anxious are there to protect you from danger, not hurt you.

4. Anxiety does not last forever. When you are anxious, you may feel like the anxiety is going to last forever. But anxiety is temporary and will eventually decrease.

5. Anxiety is mostly anonymous. Most people (except those close to you) cannot tell when you are anxious because it does not show on your face.

6. Anxiety can become a problem. Anxiety is a problem when your body reacts as if there is danger when there is no real danger. It’s like having an overly senstive smoke alarm system in your body.

7. Anxiety problems are common. 1-in-10 adults suffer from anxiety problems.

Anxiety is like a smoke alarm system:
A smoke alarm can help protect us when there is a fire but, when a smoke alarm is too sensitive and goes off when there isn’t a fire (e.g. burning toast in toaster), it is annoying.

Like a smoke alarm, anxiety is helpful and adaptive when it works properly but, if it goes off when there is no real danger, it can be scary and exhausting.

However, we DO NOT want to get rid of the alarm (or eliminate anxiety) because it protects us from danger. We want to fix it (i.e. bring the anxiety down to a more manageable level) so it works properly for us.

What Happens to Your Body When You Are Anxious?

Anxiety can cause many sensations in your body as it prepares for danger. These sensations are called the “alarm reaction”. They occur when the body’s natural alarm system (“fight-flight-freeze”) is activated.

Rapid heart beat and rapid breathing: When your body is preparing itself for action, it makes sure enough blood and oxygen are circulated to your major muscle groups and essential organs. This enables you to run away or fight off danger.
Sweating: Sweating cools the body. It also makes the skin more slippery and difficult for an attacking animal or person to grab hold of you.
Nausea and stomach upset: When faced with danger, the body shuts down systems/processes that are not needed for survival; that way it can direct energy to functions that are critical for survival. Digestion is one of the processes that is not needed at times of danger. Because of this, anxiety might lead to feelings of stomach upset, nausea or diarrhea.
Feeling dizzy or lightheaded: Because our blood and oxygen goes to major muscle groups when we are in danger, we breathe much faster to move oxygen toward those muscles. However, this can cause hyperventilation (too much oxygen from breathing very rapidly to prepare the body for action), which can make you feel dizzy or lightheaded. Also, since most of your blood and oxygen are going to your arms and legs (for “fight or flight”), there is a slight decrease of blood to the brain, which can also make you dizzy. Don’t worry– the slight decrease in blood flow to the brain is not dangerous.
Tight or painful chest: Because your muscles tense up as your body prepares for danger, your chest may feel tight or painful when you take in large breaths.
Numbness and tingling sensations: Hyperventilation (taking in too much oxygen) can also cause numbness and tingling sensations. The tingling sensations may also related to the fact that the hairs on our bodies often stand up when faced with danger to increase our sensitivity to touch or movement. Finally, fingers and toes may also feel numb/tingly as blood flows away from places where it is not needed (like our fingers) and towards major muscle groups that are needed (like our arms).
Unreality or bright vision: When responding to danger, our pupils dilate to let in more light and to make sure that we can see clearly enough. This reaction makes our environment look brighter or fuzzier, and sometimes less real.
Heavy legs: As our legs prepare for action (fight or flight), increased muscle tension as well as increased blood flow to those muscles, can cause the sensation of heavy legs.

More About How Anxiety Works

Often, how we interpret a situation determines how anxious we will feel about it and how we respond. Therefore, there are 3 parts to anxiety, specifically: physical symptoms (how our body responds); thoughts (what we say to ourselves); and behaviours (what we do or our actions). Learning to recognize these signs of anxiety can help us be less afraid.

Thoughts e.g. What if I forget what I want to say during the presentation?
Behaviours e.g. find an excuse to get out of it
Physical Symptoms e.g. stomach ache, cold sweat, racing heart

Recognizing physical symptoms of anxiety

You can learn to identify the physical signs of anxiety by asking yourself: “What happens when I’m anxious? Where do I feel the anxiety in my body?” For example, when you feel anxious, you may get butterflies in your stomach, sweat a lot, breathe heavily, and feel dizzy or lightheaded.

REMEMBER:If you often experience many uncomfortable physical symptoms, but doctors cannot find anything wrong with you physically, you may have problems with anxiety. You are definitely not “going crazy”. Although these symptoms may be uncomfortable, they are not harmful.

Recognizing anxious thoughts

Anxiety also affects how we think. Anxious thoughts typically involve a fear of something bad happening.

See Realistic Thinking for helpful tips on how to identify and challenge your anxious thoughts.

Recognizing anxious behaviours

Anxiety can make us feel very uncomfortable and make us believe we are in danger. No wonder you may feel a strong urge to escape or avoid situations/activities/people that make you anxious. For example, if you are scared of dogs, you would probably avoid going to places where you may encounter a dog (e.g. dog park).

To help you identify situations that you avoid, try to come up with as many answers as possible to the following:

If you wake up tomorrow morning and all your anxiety had magically disappeared, what would you do?
How would you act?
How would someone close to you know you weren’t anxious?

Finish the following sentences:

My anxiety stops me from…
When I am not anxious, I will be able to….

Once you are able to understand and recognize anxiety, you will be better prepared to move on to the next stage – learning General Self-Help Strategies.

9 Anxiety-Related Disorders

Agoraphobia

Individuals with this disorder experience fear using public transportation, being in open spaces, being in enclosed spaces, standing in lines, being in a crowd, and/or being outside of the home alone. They fear these situations because escape from them might be difficult in the event they develop panic or other embarrassing symptoms. They actively avoid the situations, endure it with a lot of distress, or will only go with another person.

Body Focused Repetitive Behaviours

Body-Focused Repetitive Behaviours, or BFRBs, are a cluster of habitual behaviours that include hair pulling (called Trichotillomania), skin picking (called Skin Excoriation), nail biting, nose picking, and lip or cheek biting. In both Trichotillomania and Skin Excoriation, the individual experiences ongoing and repetitive engagement in either pulling out of one’s hair or skin picking (dependent on the disorder), resulting in noticeable hair loss, or skin abrasions or lesions. This occurs despite extensive efforts to stop these behaviours. In both disorders there is significant impairment or disruption in routine life functioning for the individual.

Generalized Anxiety Disorder

Individuals with this disorder worry excessively and uncontrollably about daily life events. These worries include potential negative events in the future, minor matters, a loved one becoming ill or dying, work issues, and world events, such as natural disasters.

Hoarding Disorder (HD)

Individuals with this disorder experience ongoing and significant difficulty getting rid of possessions regardless of their value; and strong urges to save and/or acquire, often non-essential, items, that if prevented leads to extreme distress. As a result, living space becomes severely compromised with extreme clutter. In addition, the individual experiences significant impairment in social, occupational, and other important areas of functioning.

Obsessive-Compulsive Disorder

Individuals with this disorder have obsessions, or unwanted ugly thoughts that make them anxious, and/or they engage in compulsions (repetitive behaviors or mental acts) in an attempt to reduce a feeling of anxiety. Some compulsions may include repeated hand-washing, checking, tapping, or mental routines (such as counting backwards from 100). An example of an intrusive thought is “I might get sick and die from touching a bathroom door”.

Panic Disorder

Individuals with this disorder experience unexpected and repeated panic attacks, followed by at least 1 month of worry about having additional attacks. They may also fear of something bad happening as a result of the panic attack, such as going crazy, losing control or dying.

Posttraumatic Stress Disorder

Individuals with this disorder have directly experienced, witnessed or heard about a frightening traumatic event. Not everyone who has these experiences develops the disorder. Those who have the disorder also experience symptoms that may include upsetting vivid memories, nightmares, and/or flashbacks of the trauma, avoidance of reminders of the trauma, negative impact on their thoughts and mood (e.g. depression, fear of life being cut short), and changes in their reactivity (e.g. more easily startled).

Social Anxiety Disorder

Individuals with this disorder have an intense fear of social and/or performance situations and excessive concern about social embarrassment or humiliation. They may avoid social activities like going to parties, performing, speaking in front of others, or dating.

Specific Phobias

Individuals with this disorder experience persistent and excessive fears of an object or situation, which significantly interferes with life and is beyond voluntary control. Some common phobias include fear of spiders, rodents, snakes, flying, heights, and injections.

Welcome to the Complete Self-Help Home Toolkit. Here, you’ll find a resource of simple, step-by-step instructions on how to deal with symptoms related to specific anxiety disorders as well general strategies – such as how to get a good night’s sleep or how to deal with uncertainty in your daily life. There are also tips and techniques to help you relax, plan for more healthy living, set goals and change your way of thinking about things. You can choose strategies targeting specific anxiety disorders from the Self-Help Toolkit for Anxiety Disorders or look at a list of strategies in the Tools section.

Step 1: Learning About Anxiety and GAD

No matter what type of anxiety problem you are struggling with, it is important that you understand certain facts about anxiety.

Fact 1: Anxiety is a normal and adaptive system in the body that tells us when we are in danger. This means that dealing with your anxiety NEVER involves eliminating it, but rather managing it.

Fact 2: Anxiety can become a problem when our body tells us that there is danger when there is no real danger. That is, when we think or perceive that we are in danger (even when we aren’t), our body reacts as if it really is in danger.

To learn more details about anxiety, see What Is Anxiety?

As an important first step, understand that all of these worries and uncomfortable physical feelings in your body have a name: ANXIETY. Once you can identify and name the problem, you can begin dealing with it.

The next important step is to understand your GAD. Like all other anxiety disorders, adults with GAD get anxious when faced with a trigger for their worries. But what is the trigger in GAD?

Adults with GAD get anxious whenever there is uncertainty in a situation or if they are not 100% sure about something.

This is why, if you have GAD, you worry about almost anything: almost everything in life is uncertain, so there is always something to worry about.

Step 2: Identifying and Recognizing Your Worry

If GAD is the problem you are struggling with, then you are someone who worries excessively. It is this worry that leads you to feel anxious. Therefore, one of the best ways to manage your anxiety is to learn how to manage your worry.
To manage worry, you first need to become an expert at recognizing it. You probably think that you are already a “worry expert” since you do it everyday. However, when most adults are asked what they worried about during the week, they either can’t remember or they can only recall 1 or 2 “greatest hits” (most common worries) and forget about the rest.
The best way to start noticing and recognizing your worries is to begin recording them in a worry diary. Write down what you are worrying about at set times 2-3 times a day, along with the trigger for your worry and your anxiety level.

Step 3: Classifying Your Worries

There are 2 general types of worries:

Worries about current problems (e.g. “what if I don’t have enough money to pay the bills?”, “what if I don’t finish my report on time?”, “what if my argument with my friend means we never speak again?”)
Worries about hypothetical situations (e.g. “what if the flight I’m taking next month crashes?”; “what if I get a serious disease when I’m older?”)

One of the main differences between these 2 types of worries is the amount of control you have over the situation:

With worries about current problems, you have some direct control over the situation. For example, you can manage your finances, work on your report-writing, or resolve an argument with a friend.

With worries about hypothetical situations you have almost no control, so there is very little, if anything, that you can do to change the situation. For example, unless you are the pilot, you have no control over how a flight will go, and you cannot control (beyond basic good health, exercise and nutrition) whether you will contract a serious disease years from now.

Since these worry types are different, you need to manage them differently. A good way to keep track of which type of worries you have is to classify your worries in the worry diary as being either about current problems or hypothetical situations.

REMEMBER: Many people with GAD are afraid that recording and classifying their worries will make their GAD symptoms worse. This is not true. You are simply becoming an expert at catching and recognizing your worries. They are already there, you are merely observing them with greater attention. This is important if you want to be able to manage your worries.

Step 4: Building Your Worry Management Toolbox

The best way to begin managing your worry and anxiety is to start building a toolbox of strategies that you can use instead of worrying. The following is a list of tools that you can use to manage GAD.

Although the feeling of anxiety in GAD is due to your worries, it can be uncomfortable to experience anxiety in the body. Therefore, these first 2 techniques are designed to help you get a feeling of control over the anxiety in your body, and “turn the volume down” on those anxious feelings.

TOOL #1: Learning to calm anxiety by slowing down your breathing

Calm breathing involves slowing down your breathing by breathing in deeply through your nose then exhaling slowly through your mouth. It is a quick and easy way to reduce some of the physical feelings of anxiety in the body.

For more information, seeHow to do Calm Breathing

TOOL #2: Learning how to calm your anxiety by relaxing the muscles in your body

Another helpful strategy involves learning to relax your body. This involves tensing various muscles and then relaxing them. This strategy can help to lower your overall tension and stress levels that can contribute to feelings of anxiety.

For more information, see How to do Progressive Muscle Relaxation

TOOL #3: Learning to become comfortable with uncertainty

Research shows us that a major trigger for GAD worry is uncertainty. That is, whenever you are not 100% sure of something, you are likely to worry about it. For example, if you aren’t sure of a decision (even a small one, like picking a movie to watch), you are probably going to worry about it. The problem is that almost everything in life is uncertain because no one can predict the future.If the trigger is uncertainty, then the best way to deal with it is to learn to become more comfortable with it. The other option – trying to have 100% certainty – is what you are trying to accomplish when you worry. But you already know that this tactic is not very successful. If it were, you wouldn’t have a problem with worry.

So how do you become comfortable with uncertainty? The best way is by changing your behaviour to act “as if” you are comfortable with it. Examples of this strategy might be:

Not re-reading e-mails before sending them
Going to the grocery store without a list
Going to a new restaurant without reading a review
Completing a task at work without asking someone else to look it over and give their opinion on it
Delegating a task to someone else (and then not checking whether it was done correctly)

TIP: You will probably feel anxious when you try these exercises. That is a sign that you are on the right track!

For more information on how to increase your comfort with uncertainty, see How to Tolerate Uncertainty

TOOL #4: Rethinking the usefulness of worry

If you have GAD, you probably realize that you are worrying too much, and that this is not a good thing. However, what most people with GAD don’t realize is that they also often believe that worry is actually useful or helpful.As long as you think that worrying is helpful or useful in some way, you are going to want to keep worrying.In order to help you manage your worry, it is important to recognize and rethink any beliefs you might have about the usefulness of your worry. After all, your worries might not be as helpful as you think.

What are the positive beliefs that people with GAD have about worry?

Worrying shows that I am a caring person.
If you believe this, you might think, “because I worry about my family, it proves that I love and care about them”, or “people know me as the worrier; I’m the one who worries and cares for people”.
Worrying helps me to be prepared and to problem solve.
Examples of this belief include: “I do well at my job because I worry about things getting done right!”, and “when I worry about my problems, I am more likely to solve them well”.
Worrying motivates me.
If you believe this, then you might say to yourself, “worrying about my job motivates me to do well”, or “if I didn’t worry about my health, I would never go to the gym or eat right!”
Worrying protects me from negative emotions.
If you believe this, then you probably think that worrying about bad things is like “money in the bank”; that is, if you worry about bad things now, you won’t be so upset if the bad thing actually happens. An example of this type of belief is, “If something bad happened to my family and I didn’t worry about it, it would come as a surprise, and I wouldn’t be able to handle it”.
Worrying prevents bad things from happening.
If you have this belief, you might think, “I always do well at my job because I worry about it; if I stopped worrying for a day, I would do very badly at my job”, or “if I worry about my family being in a car accident, then they it won’t happen”.

How can you rethink your worries?

Trying to change your beliefs about the usefulness of worry is not as simple as saying “worry is bad”. In order for you to change your beliefs, you need to look at your beliefs and think about whether your worries are doing what you think they are doing.

Here are some questions that you can ask yourself about the worries that you think are helpful:

Worry Beliefs	Questions to Help you Rethink Your Beliefs
*Worry shows I am a caring person*	Do I know caring people who don’t worry as much as I do? What else besides worry shows that I care?
*Worry helps me to be prepared*	Am I confusing worrying (in my head) with actually doing something (i.e. actually solving problems rather than worrying about them)? Do I know people who are organized and prepared who don’t worry as much as I do?
*Worry motivates me*	Am I really more motivated when I worry? Has worrying ever actually prevented me from doing the things I want to do? (for example, worrying so much about being healthy that you actually avoid the gym?)
*Worry protects me from negative emotions*	If something bad did happen, would I really not be as upset? Has anything bad ever happened in my life? Did I really feel more prepared to deal with it because I worried about it?
*Worry prevents negative outcomes*	Has anything bad happened in my life even though I worried about it? Is there a way that I can test out my theory, by worrying one day and seeing what happens, and then not worrying another day?

Another way to rethink the usefulness of your worries is to ask yourself how much you have lost because of worrying. For example:

Has worry affected my friendships or relationships with others? Are people annoyed with me for worrying?
How much time, effort, and energy have I spent worrying? Is it worth it?
How has worry affected me physically? Am I tense all the time, often tired, or do I have trouble sleeping because of my worries?

If you find that your worries are not so helpful, that they are not doing what you think they are, and that they have cost you a lot in your life, then you can choose to learn new skills to manage your worry.

If you still believe that your worries can be helpful from time to time, ask yourself the following question: is it possible to gain the benefits I get from worrying in a way other than through worry? For example, can I be a caring person and not worry? Can I be organized, prepared and motivated without worrying all the time? If you think that it is possible to get the benefits without the worry, then you can choose to learn new skills to manage your worry.

TOOL #5: Improving your problem-solving ability

Remember when you started classifying your worries as being about current problems or hypothetical situations? One of the reasons you did this was because we manage these 2 worry types differently.

The best way to deal with worries about current problems is to use problem-solving skills and solve the problem.

Many people with GAD think that they are problem solving when they are worrying; in fact, the opposite is usually true. That is, when you worry, you are going over a problem in your head. But problem solving is active. It involves getting out of your head and carrying out a solution. Often, when people with GAD worry about a problem they will get so anxious about the problem that they avoid actually solving it, or they procrastinate.

Learning ways to improve your problem-solving ability will help you in 2 ways:

You can start solving your problems, rather than worrying about them. This will likely make you feel less anxious, and for every problem you solve, you have one less thing to worry about.
Because finding a solution to real-life problems almost always involves some uncertainty, you will also be learning to become more comfortable with uncertainty each time you use your problem-solving skills.

For information on how to deal with worries about current problems by using problem-solving skills, see How to Solve Daily Life Problems

TOOL #6: Writing a worry script

Unlike worries about current problems, using problem-solving skills is usually not very effective in dealing with worries about hypothetical situations. For example, no amount of problem solving will help you to deal with worries about developing a serious illness later on in life.

For these types of worries, the best technique is to write a worry script every day for 1 or 2 weeks.

What is a worry script?

A worry script is like a journal entry, where you write about your worry, and what you are afraid will happen. For example, if you are afraid of developing a serious illness, you might write in your worry script about how afraid you are of becoming sick, what you fear might happen, such as being in a hospital, being forgotten or abandoned by family, and missing out on all the great opportunities in life.

What will a worry script do?

Writing a worry script will help you to experience the negative emotions associated with your fears and worries, rather than avoid them. Although this will feel uncomfortable at first, research shows us that when you face your fears in this way, your anxiety and worries will go down over time. A worry script also helps you to imagine what your feared outcome would actually look like, rather than thinking about it in “fuzzy”, “blurry” or imprecise ways.

For more information, see How to Write a Worry Script.

REMEMBER: The only way to get over anxiety is to go straight through it! Most of these skills will probably make you feel more anxious when you first try them. Whenever we try something new or different, we usually feel anxious. This does not mean that you are doing something wrong. It means that you are starting to face your fears and get over them.

A helpful tool in managing your excessive worries involves writing a worry script. This skill is most useful for worries about hypothetical situations over which you have little to no control. Examples of these types of worries include:

Worries about you or a loved one developing a serious illness

Worries about you or a loved one being in an accident, getting injured, abducted or killed

Worries about failure or loss in your future (e.g. losing your job, getting divorced)

These worries take up a lot of time and energy, and they probably cause you a great deal of anxiety. In general, the best way to get over fears is to face the fear through gradual exposure. The problem is that although this kind of exposure is very helpful for getting over a fear of dogs for example, it is not very useful when your fear is of a negative event in the future that has not happened, and may never happen.

In this case, the best way to deal with your worries is to write a worry script. It is similar to a journal or diary entry, where you write out in great detail your worst fear every day for 2 weeks.

Why is a Worry Script Helpful?

Research shows us that people with Generalized Anxiety Disorder (GAD) have a hard time dealing with their negative emotions, such as sadness or fear. They either try to push the negative feelings away, or they keep switching worry topics. Unfortunately, neither of these techniques work. Why not?

Pushing bad thoughts and feelings away: If you have ever tried to push a bad feeling or thought away, you probably noticed that it didn’t work at all or that the thoughts and feelings came back pretty quickly. Trying to push something out of our minds is a little like trying to push a beach ball under water: it takes a lot of work to keep it down, and the minute you let it go, it pops right back up again.

Switching worry topics: Research on worry has found that people often “hop” from one worry topic to another. They think about one worry, which makes them feel anxious, and then they switch to another worry. The problem with this approach is that you never get to fully “digest” your fear, and really clearly see what it is that you are afraid of. Instead, you are avoiding upsetting thoughts and feelings by constantly “switching” your worries. The problem with this strategy is that avoidance doesn’t work in the long run.

So how is a worry script different? Rather than putting all of your energy into avoiding upsetting thoughts and images, you can instead face your fears head on! By writing about your biggest worry, you will be facing those negative thoughts and bad feelings. You will also get a clear picture of what it is you are really afraid of, which will give you a chance to “digest” your anxiety and change how you think about your fear. People who write a worry script for a few weeks report that they feel less anxious and worried about the worry topic they were working on.

The good news

Although you might have many worries about hypothetical situations, they usually fit into 1 or 2 themes. That is, different worries might involve a similar idea.

For example, worries about losing your job, problems in your relationship, and concerns about your personal health might all involve a theme of personal failure (that is, “what if I don’t succeed in life, and others see me as a failure?”). When you work on one worry script, your worries about a similar theme will also lessen.

How to Write a Worry Script

Your worry script should be about the worst-case scenario for one of your worries. For example, if you are worried about a loved one being in a car accident, you would write about your loved one actually being in a car accident.

Your script should be vivid and visual. That is, it should include the 5 senses as much as possible (touch, taste, sight, smell, hearing), as well as your feelings and reactions. If you were writing about a loved one in a car accident, you might describe the sound of ambulance sirens, the smell of burning tires, and feeling like you might pass out.

IMPORTANT REMINDER: If you are feeling anxious, upset or tearful while writing your script, you are on the right track. Your worry script is about your worst-case scenario, so it is supposed to be upsetting.

Remember that this exercise is designed to help you get over your worries and anxiety in the long-term. When it comes to anxiety, in order to get a long-term gain you will always experience some short-term pain.

You should write your worry script for 30 minutes every day. Set aside time in your day to do it, and eliminate distractions: turn off the ringer on your phone and the television, and go into a room by yourself to write it.

Write a new worry script every day. It should be about the same subject, for example a loved one being in a car accident, but you can go deeper into your feelings and reactions each time. For example, in one script you might write about how the loss of a loved one would affect your family, or you might write about your fears for the future after the loss of a loved one.

DON’T FORGET: If you get upset and tearful while writing your script, you are on the right track!

Expect to write about the same worry topic for 30 minutes every day for 2 weeks.

KEEP IN MIND: Sometimes when people write a worry script, they find that they worry more about the topic or generally feel more anxious during the day. This reaction is normal, and will pass. Just keep at it, and you will see that writing about your fears and negative emotions is a better strategy in the long run.

One final point

Some people who face their worries by writing a worry script are afraid that writing it down will make the worst-case scenario actually happen, or that doing this type of exposure means that they will no longer care if it happens. This is not true.

1. Just writing about something bad will not make it happen.

If that were true, you could write a script about having millions of dollars and the next day you would win the lottery. You have probably been thinking and worrying about your worst-case scenario for years. The only difference now is that you are writing it down so that you can start to let the worry go.

2. The goal of the worry script is to reduce your worry, not to make you no longer care.

If you write out your worry script every day for 2 weeks, you will find you spend less time and energy worrying about fears. However, this does not mean that you don’t care about them. It simply means that you don’t spend hours worrying about it every day.

Step 5: Building on Bravery

Remember that any progress you make in managing your worry and anxiety is due to your own hard work. If you are noticing improvements, take the time to give yourself some credit: reward yourself!

The best way to see your progress is to record all the work you do using your worry management skills. For example, write down the problems you solved, and record whether you are worrying less about that topic afterward. If you have been practicing becoming more tolerant of uncertainty, write down all of the exercises you did and rate how anxious the exercise made you (on a scale from 0 to 100). If you practice regularly, you will notice these anxiety ratings go down, and what was once hard will become easier.

How do you maintain all the progress you made?

PRACTICE, PRACTICE, PRACTICE!!

The worry management skills presented here are designed to teach you new and more effective ways of dealing with your worry. If you practice them often, they can become new habits that are a part of your daily routine.

Like an exercise program, it is important to “keep in shape” even when you are feeling better and have reached your goals.

For more information on how to maintain your progress and how to cope with relapses in symptoms, see Learning about Relapse Prevention.

For many anxious individuals, it is optimal to have a variety of tools to fight your anxiety. Having a variety of tools enables you to have more than one option if a particular tool proves insufficient to reduce unwanted anxiety, or if you feel a specific tool doesn’t work. While we encourage you to select tools that are most likely to be effective for each specific type of anxiety, the difficulties some individuals face may not fit neatly into a single category. The following list is a complete set of tools. You can choose from among this list those tools and worksheets that will best address your specific needs.

What is “Calm breathing”?

Calm breathing (sometimes called “diaphragmatic breathing”) is a technique that helps you slow down your breathing when feeling stressed or anxious. Newborn babies naturally breathe this way, as do singers, wind instrument players, and yoga practitioners.

Why is Calm Breathing Important?

Our breathing changes when we feel anxious. We tend to take short, quick, shallow breaths or even hyperventilate; this is called “overbreathing”.
It is a good idea to learn techniques for managing “overbreathing”, because this type of breathing can actually make you feel even more anxious (e.g. due to a racing heart, dizziness or headaches).
Calm breathing is a great portable tool that you can use whenever you are feeling anxious. It does require some practice.

Key point: Like other anxiety-management skills, the purpose of calm breathing is not to avoid anxiety at all costs, but just to take the edge off or help you “ride out” the feelings.

How to Do Calm Breathing

Calm breathing involves taking smooth, slow and regular breaths. Sitting upright is usually better than lying down or slouching, because it can increase the capacity of your lungs to fill with air. It is best to ‘take the weight’ off your shoulders by supporting your arms on the side-arms of a chair, or on your lap.

Take a slow breath in through the nose, breathing into your lower belly (for about 4 seconds)
Hold your breath for 1 or 2 seconds
Exhale slowly through the mouth (for about 4 seconds)
Wait a few seconds before taking another breath

About 6-8 breathing cycles per minute is often helpful to decrease anxiety but find your own comfortable breathing rhythm. These cycles regulate the amount of oxygen you take in so that you do not experience the fainting, tingling and giddy sensations that are sometimes associated with overbreathing.

Helpful Hints:

Make sure that you aren’t hyperventitating; it is important to pause for a few seconds after each breath.
Try to breathe from your diaphragm or abdomen. Your shoulders and chest area should be fairly relaxed and still. If this is challenging at first, it can be helpful to first try this exercise by lying down on the floor with one hand on your heart, the other hand on your abdomen. Watch the hand on your abdomen rise as you fill your lungs with air, expanding your chest. (The hand over your heart should barely move, if at all.)

Rules of practice:

Try calm breathing for at least 5 minutes twice a day.
You do not need to be feeling anxious to practice – in fact, at first you should practice while feeling relatively calm. You need to be comfortable breathing this way when feeling calm, before you can feel comfortable doing it when anxious. You’ll gradually master this skill and feel the benefits!
Once you are comfortable with this technique, you can start using it in situations that cause anxiety.

Questions to ask yourself to help challenge your negative thoughts or self-talk:

Am I falling into a thinking trap, e.g. catastrophizing or overestimating danger?
What is the evidence that this thought is true? What is the evidence that this it is not true?
Have I confused a thought with a fact?
What would I tell a friend if he/she had the same thought?
What would a friend say about my thought?
Am I 100% sure that ___________will happen?
How many times has __________happened before?
Is __________so important that my future depends on it?
What is the worst that could happen?
If it did happen, what could I do to cope with or handle it?
Is my judgment based on the way I feel instead of facts?
Am I confusing “possibility” with “certainty”? It may be possible, but is it likely?
Is this a hassle or a horror?

Thought_Challenging_Form.pdf

Most people would consider having high standards a good thing. Striving for excellence can show that you have a good work ethic and strength of character. High standards can also push you to reach your peak level of performance. For example, athletes often train long and hard to reach excellence in their sports.

Perfectionism, on the other hand, involves a tendency to set standards that are so high they either cannot be met or are only met with great difficulty. Perfectionists tend to believe that anything short of perfection is horrible, and that even minor imperfections will lead to catastrophe. For example, most people believe it is important to try to do one’s best and not make mistakes but also believe that making mistakes from time to time is inevitable and does not mean they have failed something entirely. However, adults with perfectionism tend to believe that they should never make mistakes and that making a mistake means they are a failure or a horrible person for disappointing others.

Thinking like this makes it very scary for them to make mistakes. Trying to be perfect is also likely to make them feel stressed and maybe even disappointed with themselves much of time because they are not able to meet their own standards easily or at all. Over time, they may even start to believe that they are not as capable as others.

Therefore, it is worthwhile considering loosening those standards a bit to ease the stress and anxiety from trying so hard to be perfect.

Here are the Steps to Help You Overcome Perfectionism

Step 1: Learning to recognize perfectionism

This is an important first step, as it helps you to figure out whether you have a problem with perfectionism. Remember, there is nothing wrong with having high standards, but when these standards are too high, they can really get in the way of your work/school, relationships and enjoyment of life.

If you have trouble figuring out whether you have a problem with perfectionism, you might find answering the following questions helpful:

Do I have trouble meeting my own standards?
Do I often feel frustrated, depressed, anxious, or angry while trying to meet my standards?
Have I been told that my standards are too high?
Do my standards get in my own way? For example, do they make it difficult for me to meet deadlines, finish a task, trust others, or do anything spontaneously?

If you answered “Yes” to any of these questions you may have a problem with perfectionism.

Perfectionism affects how one thinks, behaves, and feels. If you have difficulties with perfectionism, the following examples may be familiar to you:

Examples of perfectionistic feelings:

Perfectionism can make you feel depressed, frustrated, anxious, and even angry, especially if you constantly criticize yourself for not doing a good enough job after spending a lot of time and effort on a task

Examples of perfectionistic thinking:

Black-and-white thinking (e.g. “Anything less than perfection is a failure”, “If I need help from others, then I am weak”)
Catastrophic thinking (e.g. “If I make a mistake in front of my coworkers, I won’t be able to survive the humiliation”; “I can’t handle having someone being upset with me.”)
Probability overestimation (e.g. “Although I spent all night preparing for a presentation, I know I won’t do well” ; “My boss will think I am lazy if I take a couple of sick days.”)
Should statements (e.g. “I should never make mistakes” ; “I should never come across as nervous or anxious” ; “I should always be able to predict problems before they occur.”)

Examples of perfectionistic behaviour:

Chronic procrastination, difficulty completing tasks, or giving up easily
Overly cautious and thorough in tasks (e.g. spending 3 hours on 1 task that takes others 20 minutes to complete)
Excessive checking (e.g. spending 30 minutes looking over a brief email to your boss for possible spelling mistakes)
Constantly trying to improve things by re-doing them (e.g. rewriting a work document several times to make it “perfect”)
Agonizing over small details (e.g. what movie to rent)
Making elaborate “to do” lists (e.g. when to get up, brush teeth, shower, etc.)
Avoiding trying new things and risking making mistakes

TIP: You might want to write down the realistic statements on cue cards and carry them with you. This can help you when you have a hard time thinking realistically.

Step 2: Tools to overcome perfectionism

Tool #1: Changing perfectionistic thinking

a) Realistic thinking

Because adults with perfectionism are often very critical of themselves, one of the most effective ways to overcome perfectionism is to replace self-critical or perfectionistic thoughts with more realistic and helpful statements.
It is a good idea to practise these helpful statements regularly. Even if you do not believe them right away, enough repetition will turn positive realistic thoughts into a habit, and help crowd out the negative self-talk.

Some examples of positive realistic statements

“Nobody is perfect!”
“All I can do is my best!”
“Making a mistake does not mean I’m stupid or a failure. It only means that I am like everyone else – human. Everyone makes mistakes!”
“It’s okay not to be pleasant all the time. Everyone has a bad day sometime.”
“It’s okay if some people don’t like me. No one is liked by everyone!”

b) Perspective taking

Adults with perfectionism also tend to have a hard time seeing things from another person’s point of view. That is, they tend not to think about how others might see a situation. For example, you may believe that you are lazy because you are only able to exercise 1 hour instead of 2 hours every day. Learning to view situations as other people might see them can help you to change some of these unhelpful beliefs.

Going back to the “I’m lazy” example, you can challenge this thought by asking yourself the following questions:

How might someone else (e.g. a close friend) view this situation? Most people probably would not think they are lazy if they do not exercise 2 hours everyday. Kelly, my best friend, only has time to work out for 1 hour, 2 to 3 times a week, and feels pretty good about it.
Are there other ways to look at this? Maybe not being able to work out 2 hours every day is understandable given my busy schedule. Not being able to meet this standard does not mean I am lazy. Most people cannot do it.
What might I tell a close friend who was having similar thoughts? It is okay to only workout for 1 hour a day or less. Working out regularly, say 2 to 3 times a week, is good.

c) Looking at the big picture

Adults with perfectionism tend to get bogged down in details and spend a lot of time worrying about ”the little things” (e.g. what font to use in an email). One helpful strategy to worry less about details is to ask yourself the following questions:

Does it really matter?
What is the worst that could happen?
If the worst does happen, can I survive it?
Will this still matter tomorrow? How about next week? Next year?

d) Compromising

This is a particularly helpful tool for dealing with black-and-white thinking. Compromising involves setting more realistic standards or being more flexible with your very high standards.

For example, if you believe that making a mistake during a presentation means that you are stupid, try asking yourself, “What level of imperfection am I willing to tolerate?” From there, you can try to come up with more reasonable standards that you are willing to accept. Because it is quite anxiety provoking when you first start trying to re-set/lower your standards, you can do so gradually, in steps. For example, the first step to more reasonable standards in this example might involve spending 3 hours instead of 5 preparing for a presentation, allowing yourself to make a mistake during 1 out of 5 presentations, or being okay with having fewer than 5 people praise your performance. Once you are comfortable with lowering your standards a bit, lower them some more. For example the next step might involve spending 1 hour preparing for the presentation, allowing yourself to make a mistake during 1 out 2 presentations, or being okay with not knowing what others think of your performance.

Tool #2: Changing perfectionistic behavioursHaving a problem with perfectionism is a lot like having a “phobia” of making mistakes or being imperfect – you are terrified of making mistakes. Facing fears in a gradual and consistent manner is the most effective way to overcome phobias, and is called “exposure”. For example, the best way to overcome a dog phobia is to gradually spend time with dogs, to learn that they are not as scary and dangerous as you initially thought.

Similarly, overcoming your “phobia” of making mistakes or being imperfect involves doing just that–gradually and purposely making mistakes and coming across as imperfect. This technique also involves gradually putting yourself into situations that you usually avoid out of a fear that things won’t work out perfectly. For tips on how to reduce your fears, see Facing Your Fears: Exposure.

Here are some examples to help you brainstorm items for exposure practice:

Show up for an appointment 15 minutes late
Leave a visible area in the house a little messy
Tell people when you are tired (or other feelings that you consider a weakness)
Wear a piece of clothing that has a visible stain on it
Purposely allow several uncomfortable silences to occur during lunch with a co-worker
Purposely be a few cents short for bus fare
Lose your train of thought during a presentation
Send a letter or e-mail that includes a few mistakes
Talk at a meeting without first rehearsing what you are going to say in your head
Try a new restaurant without first researching how good it is

Another helpful hint: Stop yourself from engaging in excessive behaviours designed to prevent imperfection. For example, if you tend to repeatedly check written documents for mistakes, stop yourself from checking more than once. Or, spend 30 minutes instead of 2 hours to prepare for a 15 minute presentation.
Repeated and frequent practice! You will need to practise the technique you choose several times before you start to feel more comfortable with making mistakes. Don’t be discouraged if your anxiety doesn’t lessen right away, this is normal and expected. Keep trying and repeating the exposure as frequently as you can.

More about setting realistic standards:
Are you scared of lowering your standards because you worry that you will let too many of your standars go and you might make mistakes all the time? Here are some helpful tips to address your worry:

Tip 1: Remember, lowering your standards DOES NOT mean having no standards. The goal is to set realistic standards, not to make you become careless in life and perform poorly all the time. Realistic standards can actually help you to do your best without costing you things that may be important to you, such as family life, physical and mental health, and leisure time.Do you feel ambivalent about lowring your standards? If you are not sure whether you should lower certain standards, it is a good idea to make a list of pros and cons for lowering those standards. What are the costs to holding onto your standards? Keeping the costs in mind can help you to take the brave steps towards changing.
Tip 2: It is okay to ask for help. Sometimes, it is difficult to know how to lower an unrealistic standard to a more reasonable level. It is a good idea to ask a supportive person who does not have problems with perfectionism to help you with setting new, realistic standards.

Tool #3: Overcoming procrastination

Many adults with perfectionism often cope with their fear of making mistakes by procrastinating. When you set “perfect” standards for yourself, sometimes it might feel easier to procrastinate carrying out a task rather than spending hours trying to do it. For example, you might find that your house is usually messy even though you have very high standards of cleanliness and organization. Or, you might put off writing a report for work because you are afraid that you won’t be able to complete the task “perfectly”, or you might be overwhelmed by how much work you have to put into it and don’t know where to start. However, procrastination is only a temporary solution, and it tends to make your anxiety worse over time. Here are some ways to help you to overcome procrastination:

Creating realistic schedules. Break down larger tasks into manageable steps. On a chart or calendar, write down the goal or deadline, and work towards it, setting small goals for yourself along the way. Don’t forget to reward yourself for reaching each goal. It is also helpful to decide in advance how much time you will spend on a task. Remember, the goal is to complete the task, not to make it perfect!
For more information on how to set realistic and doable goals, see the Guide to Goal Setting.
Setting priorities. Perfectionists sometimes have trouble deciding on where they should devote their energy and effort. Prioritize your tasks by deciding which are the most important to accomplish, and which are less important. It is O.K. not to give 100% on every task.

Step 3: Reward yourself

Because it is hard work to face your fears and change old ways of doing things, make sure to always take the time to reward yourself for all the work you are doing. It is very motivating to give yourself a treat once in a while. A reward might include going out for a nice meal, taking a walk, going out with friends, or just taking some time to relax or pamper yourself.

Some helpful resources for more information on overcoming perfectionism:

When Perfect Isn’t Good Enough: Strategies for Coping with Perfectionism by M. M. Antony & R. P. Swinson (New Harbinger Publications)

Never Good Enough: How to Use Perfectionism to Your Advantage without Letting It Ruin Your Life by M.R. Basco (Simon & Schuster)

Perfectionism: What’s Bad about Being Too Good? By M. Adderholdt-Elliott, M. Elliott, & J. Goldberg (Monarch Books)

An important step in managing anxiety involves facing feared situations, places or objects. It is normal to want to avoid the things you fear. However, avoidance prevents you from learning that the things you fear are not as dangerous as you think.

The process of facing fears is called EXPOSURE. Exposure involves gradually and repeatedly going into feared situations until you feel less anxious. Exposure is not dangerous and will not make the fear worse. And after a while, your anxiety will naturally lessen.

Starting with situations that are less scary, you work your way up to facing things that cause you a great deal of anxiety. Over time, you build up confidence in those situations and may even come to enjoy them. This process often happens naturally. A person who is afraid of the water takes swimming lessons every week and practices putting their feet and legs in the water, then the whole body and, finally, diving underwater. People with a fear of water can learn to love swimming. The same process occurs when people learn to ride a bike, skate or drive a car.

Doubts about the helpfulness of exposure?
You may have tried exposure in the past and found that it did not work. However, you may have tried to face something too scary too soon, which can be overwhelming. Or, you didn’t have the chance to practice repeatedly in order to get the benefits of exposure. If done correctly, exposure can be VERY effective in overcoming fears. Be willing to try again! Follow the steps below to get the most out of exposure.

Exposure is one of the most effective ways of overcoming fears. However, it takes some planning and patience.

How To Do It

Step 1. Make a list

Make a list of situations, places or objects that you fear. For example, if you are afraid of dogs, the list may include: looking at pictures of dogs; standing across the park from a dog on a leash; standing in the same room as a dog on a leash; standing a few feet from a dog; or petting a puppy. If you are afraid of social situations, the list may include: saying “Hi” to a co-worker; asking a stranger a question; making small talk with a cashier; or calling a friend on the phone.

HELPFUL HINT: Group Fears Together. Some people have a lot of different fears, so it can help to group similar fears or specific fear themes together. For example, you may have a fear of bugs, as well as a fear of heights. Make different lists for different fear themes.

Step 2. Build a fear ladder

Once you have made a list, arrange things from the least scary to the most scary. You can do this by rating how much fear you have for each situation on the list, from “0” (No fear) to “10” (Extreme fear). Once you have rated each situation, use the Fear Ladder form to make a final list.

HELPFUL HINTS: When making a fear ladder, identify a specific goal, such as having a meal in a restaurant. Then list the steps needed to achieve that goal (e.g. go to a restaurant and get a coffee to go; have a coffee at the restaurant and sit near the door; have a snack at the restaurant and sit near the door; have a snack at the restaurant and sit at a table in the middle of the room; have a meal at the restaurant and sit near the door; have a meal at the restaurant and sit in the middle of the room). See Examples of Fear Ladders for some ideas on building your fear ladder.

If you have a lot of different fears, build separate ladders for each fear theme.
Each ladder should include a whole range of situations. The ladder should include some steps you can do now with mild anxiety, some that you can do now with moderate anxiety and, finally, the steps you find too difficult to do now. It is important to start really small and take gradual steps.
Some steps on the ladder can be broken down into smaller steps. For example, if you are afraid to talk to co-workers, facing this situation could be broken up into a number of steps such as saying “Hi” to a co-worker, asking a quick question, and then talking about your weekend.
Because it is sometimes difficult to come up with steps on the fear ladder that cause only moderate anxiety (that is, somewhere between a little and very scary), you can consider other factors that might make it easier or harder for you to do.

Some examples include:

Length of time: e.g. talking to someone for 30 seconds is probably less scary than talking for 5 minutes
Time of day: e.g. driving over a bridge in the middle of the afternoon versus evening rush hour
Environment: e.g. swimming at a local pool versus swimming in a lake
Who is with you: e.g. going to the mall with your spouse versus alone

See Examples of Fear Ladders for some ideas about building your fear ladder.

Step 3. Facing fears (exposure)

Starting with the situation that causes the least anxiety, repeatedly engage in that activity (e.g. saying “Hi” to the bus driver everyday) until you start to feel less anxious doing it. If the situation is one that you can remain in for a prolonged period of time, such as standing on a balcony, stay in the situation long enough for your anxiety to lessen (e.g. standing on the balcony
for 20 to 30 minutes). If the situation is short in duration, try “looping” it, which involves doing the same thing over and over again for a set number of times (e.g. repeatedly driving back and forth over a bridge until you start to feel less anxious or making consecutive phone calls until you feel more comfortable doing it).
If you stay in a situation long enough (or continue engaging in a specific activity), your anxiety will start to reduce. This is because anxiety takes a lot of energy and at some point it “runs out of gas”. The longer you face something, the more you get used to it and the less anxious you will feel when you face it again.

HELPFUL HINT: It can help to track your fear level during exposure exercises and to try and remain in those situations (or continue engaging in a specific activity) until your fear level drops by about 50%. For example, if you rated holding a needle as a 6/10 on the fear scale (remember that “0” = no fear and “10” = extreme fear) then you want to continue holding the needle until your fear level drops to a 3/10.

It is important to plan exposure exercises in advance,that way you feel more in control of the situation. Identify what you are going to do and when you plan to do it.

Remember – Exposures should be planned, prolonged, and repeated!
Make sure to track your progress. See the Facing Fears form, which will help you identify how anxious you were before and after facing the feared situation, and what you learned. Make copies and fill 1 out each time you face a fear.
Once you are able to enter a specific situation on several separate occasions without experiencing much anxiety, you can move on to the next thing on the list.

Key: Don’t Rush! It can be very scary facing the things you fear. Be patient and take your time. Go at a pace that you can manage.

Step 4. Practice

It is important to practice on a regular basis. Some steps can be practiced daily (e.g. driving over a bridge, taking an elevator, saying “hi” to a stranger, touching doorknobs), while other steps can only be done once in a while (e.g. giving a formal presentation to a large group or taking a plane trip). However, the more often you practice, the faster the fear will fade.
Don’t forget to maintain the gains that you have made. Even if you have become comfortable doing something, it’s important to keep exposing yourself to it from time to time, so your fears don’t creep back. For example, if you have overcome a fear of needles, you should schedule routine blood tests or donate blood every 6 months so that your fear of needles does not return.
Re-rate your entire fear ladder every once in a while; that way you can see the progress you have made and identify the steps on the ladder you still need to tackle.

Remember, you will experience anxiety when facing fears – this is normal.

Step 5. Reward brave behaviour

It’s not easy facing fears. Reward yourself when you do it!
It may be helpful to use specific rewards as a motivation to achieve a goal. For example, plan to purchase a special gift for yourself (DVD, CD, book, treat) or engage in a fun activity (rent a movie, go to the movies, go out for lunch or dinner, plan a relaxing evening) after you reach a goal.
Don’t forget the power of positive self-talk (e.g. “I did it!”).

TIP: Don’t be discouraged if your fears start creeping back. This can happen from time to time, especially during stressful periods or transitions (for example, starting a new job or moving). This is normal. It just means that you need to start practicing using the tools – plan some exposures. Remember, coping with anxiety is a lifelong process.

For more information on how to maintain your progress and how to cope with relapses in symptoms, see How to Prevent a Relapse .

Progressive Muscle Relaxation teaches you how to relax your muscles through a 2-step process. First, you systematically tense particular muscle groups in your body, such as your neck and shoulders. Next, you release the tension and notice how your muscles feel when you relax them. This exercise will help you to lower your overall tension and stress levels, and help you relax when you are feeling anxious. It can also help reduce physical problems such as stomachaches and headaches, as well as improve your sleep.

People with anxiety difficulties are often so tense throughout the day that they don’t even recognize what being relaxed feels like. Through practice you can learn to distinguish between the feelings of a tensed muscle and a completely relaxed muscle. Then, you can begin to “cue” this relaxed state at the first sign of the muscle tension that accompanies your feelings of anxiety. By tensing and releasing, you learn what relaxation feels like and how to recognize when you are starting to get tense during the day.

HELPFUL HINTS:

Set aside about 15 minutes to complete this exercise
Find a place where you can complete this exercise without being disturbed
For the first week or two, practice this exercise twice a day until you get the hang of it. The better you become at it, the quicker the relaxation response will “kick in” when you really need it
You do not need to be feeling anxious when you practice this exercise. In fact, it is better to first practice it when you are calm. That way, it will be easier to do when feeling anxious

Getting Ready

Find a quiet, comfortable place to sit, then close your eyes and let your body go loose. A reclining armchair is ideal. You can lie down, but this will increase your chances of falling asleep. Although relaxing before bed can improve your sleep, the goal of this exercise is to learn to relax while awake. Wear loose, comfortable clothing, and don’t forget to remove your shoes. Take about 5 slow, deep breaths before you begin.

How to do Progressive Relaxation

The tension – relaxation response

Step 1: Tension

The first step is applying muscle tension to a specific part of the body. This step is essentially the same regardless of which muscle group you are targeting. First, focus on the target muscle group, for example, your left hand. Next, take a slow, deep breath and squeeze the muscles as hard as you can for about 5 seconds. It is important to really feel the tension in the muscles, which may even cause a bit of discomfort or shaking. In this instance, you would be making a tight fist with your left hand.

It is easy to accidentally tense other surrounding muscles (for example the shoulder or arm), so try to ONLY tense the muscles you are targeting. Isolating muscle groups gets easier with practice.

Be Careful! Take care not to hurt yourself while tensing your muscles. You should never feel intense or shooting pain while completing this exercise. Make the muscle tension deliberate, yet gentle. If you have problems with pulled muscles, broken bones, or any medical issues that would hinder physical activity, consult your doctor first.

Step 2: Relaxing the tense muscles

This step involves quickly relaxing the tensed muscles. After about 5 seconds, let all the tightness flow out of the tensed muscles. Exhale as you do this step. You should feel the muscles become loose and limp, as the tension flows out. It is important to very deliberately focus on and notice the difference between the tension and relaxation. This is the most important part of the whole exercise.

Note: It can take time to learn to relax the body and notice the difference between tension and relaxation. At first, it may feel uncomfortable to be focusing on your body but with time it can become quite enjoyable.

Remain in this relaxed state for about 15 seconds, then move on to the next muscle group. Repeat the tension-relaxation steps. After completing all of the muscle groups, take some time to enjoy the deep state of relaxation.

The different muscle groups

During the progressive relaxation exercise, you will be working with almost all the major muscle groups in your body. To make it easier to remember, start with your feet and systematically move up (or if you prefer, you can do it in the reverse order, from your forehead down to your feet). For example:

Foot (curl your toes downward)
Lower leg and foot (tighten your calf muscle by pulling toes towards you)
Entire leg (squeeze thigh muscles while doing above)

(Repeat on other side of body)

Hand (clench your fist)
Entire right arm (tighten your biceps by drawing your forearm up towards your shoulder and “make a muscle”, while clenching fist)

(Repeat on other side of body)

Buttocks (tighten by pulling your buttocks together)
Stomach (suck your stomach in)
Chest (tighten by taking a deep breath)
Neck and shoulders (raise your shoulders up to touch your ears)
Mouth (open your mouth wide enough to stretch the hinges of your jaw)
Eyes (clench your eyelids tightly shut)
Forehead (raise your eyebrows as far as you can)

It can be helpful to listen to someone guide you through these steps. There are many relaxation CDs for sale that will take you through a progressive muscle relaxation (or something very similar). Alternatively, you can record a script of this process on a tape or CD, or ask a friend or relative with a calm, soothing voice to record it for you. It would sound something like this:

Take a deep breath in through your nose…hold your breath for a few seconds…and now breathe out…take another deep breath through your nose… Now pay attention to your body and how it feels…. Start with your right foot… squeeze all the muscles in your right foot. Curl your toes as tight as you can, now hold it….hold it…good…now relax and exhale…let your foot go limp…notice the difference between the tension and relaxation….feel the tension flow out of your foot like water…(then repeat with right lower leg and foot, entire right leg, etc.).

Quick tense and relax

Once you have become familiar with the “tension and relaxation” technique, and have been practicing it for a couple weeks, you can begin to practice a very short version of progressive muscle relaxation. In this approach, you learn how to tense larger groups of muscles, which takes even less time. These muscle groups are:

Lower limbs (feet and legs)
Stomach and chest
Arms, shoulders, and neck
Face

So instead of working with just one specific muscle group at a time (e.g. your stomach), you can focus on the complete group (your stomach AND chest). You can start by focusing on your breathing during the tension and relaxation. When doing this shortened version, it can be helpful to say a certain word or phrase to yourself as you slowly exhale (such as “relax”, “let go”, “stay calm”, “peace” “it will pass” etc.). This word or phrase will become associated with a relaxed state; eventually, saying this word alone can bring on a calm feeling. This can be handy during times when it would be hard to take the time to go through all the steps of progressive muscle relaxation.

Release only

A good way to further shorten the time you take to relax your muscles is to become familiar with the “release only” technique. One of the benefits of tensing and releasing muscles is that you learn to recognize what tense muscles feel like and what relaxed muscles feel like.

Once you feel comfortable with the tension and relaxation techniques, you can start doing “release only”, which involves removing the “tension” part of the exercise. For example, instead of tensing your stomach and chest before relaxing them, try just relaxing the muscles. At first, the feeling of relaxation might feel less intense then when you tensed the muscles beforehand, but with practice, the release-only technique can be just as relaxing.

Final Note: Remember to practice progressive muscle relaxation often, whether you are feeling anxious or not. This will make the exercise even more effective when you really do need to relax. Though it may feel a bit tedious at first, ultimately you will gain a skill that will probably become a very important part of managing your anxiety in your daily life

Building good relationships with other people can greatly reduce stress and anxiety in your life. In fact, improving your social support is linked to better mental health in general, since having good friends can act as a “buffer” for feelings of anxiety and low mood. This is especially true if you are socially anxious and desperately want to make friends but are either too fearful to do so or are unsure about how to reach out to others. As a result of these anxious feelings, you may even be avoiding social situations.

Unfortunately, one of the consequences of avoiding social situations is that you never have the opportunity to:

Build up your confidence interacting with others
Develop strong communication skills that would increase the chance for successful relationships

For example, if you are afraid of going to parties or asking someone out on a date, your lack of confidence and experience will make it even MORE difficult to know how to handle these situations (like what to wear, what to say, etc.). Often, people have the necessary skills but lack the confidence to use them. Either way, practice will increase your confidence and improve your communication skills.

Why Are Communication Skills Important?

Communication skills are the key to developing (and keeping) friendships and to building a strong social support network. They also help you take care of your own needs, while being respectful of the needs of others. People aren’t born with good communication skills; like any other skill, they are learned through trial and error and repeated practice.

3 areas of communication that you may want to practice are:

Non-verbal communication
Conversation skills
Assertiveness

Note: Of course, there are many aspects to effective communication and you may want more specific help in certain areas (e.g. learning how to deal with conflict, presentation skills, giving feedback, etc.). For more specific help, please see the “Recommended Readings” list at the end of this module.

Nonverbal Communication

A large part of what we communicate to each other is nonverbal. What you say to people with your eyes or your body language is just as powerful as what you say with words. When you feel anxious, you might behave in ways that are designed to avoid communicating with others. For example, you may avoid eye contact or speak very softly. In other words, you are trying not to communicate, likely to avoid being judged negatively by others. However, your body language and tone of voice does communicate powerful messages to others about your:

Emotional state (e.g. impatience, fear)
Attitude towards the listener (e.g. submissiveness, contempt)
Knowledge of the topic
Honesty (do you have a secret agenda?)

Thus, if you are avoiding eye contact, standing far away from others, and speaking quietly, you are likely communicating, “Stay away from me!” or “Don’t talk to me!” Chances are, this is not the message that you want to send. Below are some steps that can help you get started in identifying any deficits and improving your non-verbal skills.

Step 1: Identifying your trouble spots

To get started, ask yourself a few questions:

Do I have trouble maintaining eye contact when talking with others?
Do I smile too much because of nervousness? Too little?
Do I slouch?
Do I keep my head down?
Do I speak with a timid voice?
Do I speak too quickly when I am anxious?
Do I cross my arms and legs?

Some of the nonverbal behaviours you may want to pay attention to are:

Posture (e.g. head up and alert, leaning forward)
Movement and gestures (e.g. keeping arms uncrossed)
Physical distance (e.g. standing closer when talking to others)
Eye contact (e.g. making appropriate eye contact when talking)
Facial expression (e.g. smiling warmly)
Volume of voice (speaking at a volume easily heard)
Tone of voice (e.g. speaking with a confident tone)

Note: Many of the above examples are culturally related. For example, in Western societies, it is generally accepted that frequent eye contact while listening, and looking away slightly more often while speaking, are appropriate.

Step 2: Experiment with and practice non-verbal skills

Try to practice only 1 skill at a time, so you can make sure you have mastered it before moving on to the next skill.
You may want to ask a trusted friend or relative to give you some feedback on your non-verbal behaviour. This feedback can be very useful, as often, we do not really know how we appear to others.
If you are able to, it may be useful to videotape yourself having a conversation, and note what your body language may be communicating. Once you have identified a couple of trouble spots, practice the appropriate body language.
You can also practice your new non-verbal skills in front of a mirror.
Once you have gained a little confidence and practice using nonverbal communication skills at home, try it out in real interactions. It is a good idea to start small by talking to clerks, tellers, and cashiers at stores for example. Try increasing the amount of eye contact you make when talking with others; smile more and pay attention to the reactions of others. For example, is the bank teller friendlier or more chatty when you give her more eye contact and smile more?

Conversation Skills

One of the biggest challenges for someone with social anxiety is starting conversations and keeping them going. It is normal to struggle a bit when you are trying to make small talk, because it is not always easy to think of things to say. This is especially true when feeling anxious. On the other hand, some anxious people talk too much, which can have a negative impression on others.

Step 1: Identifying your trouble spots

Below are some questions that you may want to ask yourself to identify the areas you want to work on:

Do I have trouble starting conversations?
Do I quickly run out of things to say?
Do I tend to say “yes”, nod and try to keep other people talking to avoid having to talk?
Am I reluctant to talk about myself?

Tips for Starting a Conversation:

Start a conversation by saying something general and not too personal, for example talk about the weather (“Gorgeous day, isn’t it?”); pay a compliment (“That sweater looks great on you”); make an observation (“I noticed that you were reading a book on sailing, do you have a boat?”); or introduce yourself (“I don’t think we have met, I’m…”).
You don’t need to say anything extremely witty. It’s better to be sincere and genuine.
Once you have talked for a while, especially if you have known the person for some time, it might be appropriate to move on to more personal topics,e.g relationships; family matters; personal feelings; spiritual beliefs; etc.
Remember to pay attention to your nonverbal behaviour–make eye contact and speak loudly enough so that others can hear you.

Tips for Keeping a Conversation Going:

Remember that a conversation is a 2-way street – don’t talk too little, or too much. As much as possible, try to contribute to about one-half of the conversation when speaking 1-on-1.
Disclose some personal information about yourself, such as your weekend activities, your favourite hockey team, or a hobby or interest. Personal information does not need to be “too personal”; you can start with giving your opinion about movies and books, or talking about things that you like doing.
Try to show a little vulnerability: it can even be OK to admit that you are a bit nervous (for example, “I never know what to say to break the ice”, or “I’m always so nervous at parties where I hardly know anyone”). However, take care – sometimes disclosing too much too soon can put others off.
Ask questions about the other person but when you are first getting to know someone, take care not to ask questions that are too personal. Appropriate questions might be to ask about their weekend activities, their preferences, or their opinion about something you said. For example, “How do you like that new restaurant?”
Try to ask open-ended questions rather than close-ended questions. A close-ended question is one that is answered by a few words, such as yes or no, for example, “Do you like your job?” In contrast, an open-ended question invites much more detail; for example, “How did you get into your line of work?”
Do I talk too much when I’m nervous?

Remember: People generally like to talk about themselves, especially if the other person is showing genuine interest.

Tips for Ending a Conversation:

Remember, all conversations end sometime – don’t feel rejected or become anxious as a conversation nears its end. Running out of things to talk about doesn’t mean you are a failure or that you are boring.
Think of a graceful way to end the conversation. For example, you can say that you need to refill your drink, catch up with another person at a party, get back to work, or you can promise to continue the conversation at a later time or date (e.g. “Hope we’ll have a chance to chat again,” or “Let’s have lunch together soon.”)

Step 2: Experiment with and practice your conversation skills

The next time you have an opportunity to practice starting or ending a conversation, try breaking some of your normal patterns. For example, if you tend not to speak about yourself, try to share your thoughts and feelings a bit more and see what happens. Or, if you tend to wait for the other person to end the conversation, try a graceful exit yourself first.

Below are a few suggestions for some practice situations:

Speak to a stranger: e.g. at a bus stop, in an elevator or waiting in line.
Talk to your neighbours: e.g. about the weather or something going on in the neighbourhood.
Interact with co-workers: e.g. chat with co-workers on your coffee break or in the staffroom at lunch.
Have friends over for a get-together: e.g. invite a co-worker or acquaintance over, meet someone for coffee, or throw a birthday party for a relative. Make sure you interact with your guests.
Try giving a compliment: Resolve to give at least 2 compliments each day – preferably ones that you would not normally give. But remember to always be sincere: only pay a compliment to someone if you truly believe what you are saying.

Hint: If you are unsure, use a video or audiotape to practice.
While you might feel a little silly at first remember, you are just experimenting.
Have fun with it!

Assertiveness

Assertive communication is the honest expression of one’s own needs, wants and feelings, while respecting those of the other person. When you communicate assertively, your manner is non-threatening and non-judgmental, and you take responsibility for your own actions.

If you are socially anxious, you may have some difficulty expressing your thoughts and feelings openly. Assertiveness skills can be difficult to learn, especially since being assertive can mean holding yourself back from the way you would normally do things. For example, you may be afraid of conflict, always go along with the crowd, and avoid offering your opinions. As a result, you may have developed a passive communication style. Alternatively, you may aim to control and dominate others and have developed an aggressive communication style.

However, an assertive communication style brings many benefits. For example, it can help you to relate to others more genuinely, with less anxiety and resentment. It also gives you more control over your life, and reduces feelings of helplessness. Furthermore, it allows OTHER people the right to live their lives.

Remember: Assertiveness is a learned skill, not a personality trait you are born with. It is what you do, not who you are.

Step 1: Identifying your trouble spots

To start, ask yourself the following questions to identify what area(s) to work on:

Do I struggle to ask for what I want?
Is it hard to state my opinion?
Do I have trouble saying no?

Tips for Communicating Assertively:

Many people find it hard to ask for what they want, feeling that they don’t have the right to ask, or fearing the consequences of the request. For example, you may think, “What if he says no?” or “She would think I am rude for asking”.
When making a request, it can be helpful to start by saying something that shows you understand the other person’s situation. For example, “I know you probably have had a lot on your mind lately.”
Next, describe the situation and how you feel about it. For example, “This presentation is due next Friday and I am feeling pretty overwhelmed, and worried that I won’t be able to get it done in time.” It is important to talk about your feelings, not to make accusations to others. For example, it is better to say, “I feel resentful when you show up late to meet me” than it is to say, “you are always late! You don’t care about me!”
Then, describe what you would like to see happen. Be as brief and positive as possible. For example, “I’d really like to figure out how we can share more of the work responsibilities.”
Last, tell the person what would happen if your request was honoured. How would you feel? Sometimes, you may want to add what you will do in return. For example, “I would make sure to help create the slides for your presentation next week.”
Many people have trouble expressing their views openly. Perhaps you wait for others to give their opinion first, and will share yours only if you happen to agree. Being assertive means being willing to state your opinion, even if others haven’t done so or if your opinion is different.
Being assertive means that you “own” your opinion; that is, you take responsibility for your view; for example, “My personal view is that it was unfair for her to ask that of you.”
Being assertive also means being willing to consider new information, and even changing your mind. However, it does not mean changing your mind just because others think differently.

Tips for Saying “No”

Saying “No” can be difficult if you are usually more passive. However, if you are not able to say no to others, you are not in charge of your own life.
When saying “No”, remember to use assertive body language (e.g. standing straight, eye contact, speaking loudly enough that the other person can hear).
Before you speak, decide what your position is. For example, think about how you will say “No” to a request, such as, “I would like to help you out but I already have quite a bit of work to get done this week.”
Make sure to actually wait for the question, and don’t say “Yes” before the other person even makes the request.
Take care not to apologize, defend yourself or make excuses for saying “No” when it is not necessary.
If saying “No” right away is too difficult, practice telling someone, “I need to think about it” as a first step. This will help break the cycle of always saying yes, and will give you a chance to think about what you really want to do.

Remember: Everyone has the right to say “No!”

Step 2: Practice your new assertiveness skill

First, think of a couple of past scenarios when you avoided giving your opinion or preference, saying “No”, or asking for what you wanted. How could you have handled the situation differently? What would be an assertive way to communicate in those situations?
Practice saying your assertive statement out loud to yourself, to get used to it. For example, “Actually, I thought the movie dragged on a bit”, “Unfortunately, I can’t help you out next weekend”, or “I’d like the dishes done before 9 o’clock”.
Next, think of a situation that is coming up in the next week in which you could use your assertiveness skills. Begin with a scenario that is easier, for example, giving your opinion or saying “No” to more familiar people, and then try it in more difficult situations.
Try it out – how did it go? Notice how the other person reacted. Would you do something differently next time? Remember: assertiveness is like any new skill, and requires time and practice. Don’t be too hard on yourself if you are feeling nervous, or not getting it quite right. Reward yourself when you do speak up!

Note: Sometimes people who are not used to us being assertive may need some time to adjust. Just because people may not initially respond in a positive way, doesn’t mean that being assertive is wrong – they just need to adjust to the change!

Barriers to Behaving Assertively – Myths about Assertiveness

Myth #1: Assertiveness means getting your own way all the timeThis is not true. Being assertive means expressing your point of view and communicating honestly with others. Often, you may not get “your own way” when you are assertively giving your opinion. But telling others how you feel and trying to work out a compromise shows respect for both yourself and others.
Myth #2: Being assertive means being selfishThis is false. Just because you express your opinions and your preferences does not mean that other people are forced to go along with you. If you express yourself assertively (not aggressively) then you make room for others. You can also be assertive on behalf of someone else (e.g. I would like Susan to choose the restaurant this week).
Myth #3: Passivity is the way to be lovedThis is false. Being passive means always agreeing with others, always allowing them to get their own way, giving into their wishes, and making no demands or requests of your own. Behaving this way is no guarantee that others will like or admire you. In fact, they may perceive you as dull and feel frustrated that they can’t really get to know you.
Myth #4: It’s impolite to disagreeThis is not true. Although there are some situations where we don’t give our honest opinion (e.g. most people say how beautiful a friend looks in her wedding dress, or we only say positive things on the first day of a new job). Much of the time, however, other people will be interested in what you think. Think how you would feel if everyone always agreed with you.
Myth #5: I have to do everything I am asked to doFalse. A central part of being assertive is setting and keeping personal boundaries. This is difficult for many people. With our friends, we may worry that they will think we are selfish and uncaring if we don’t do everything they ask. At work, we may worry that others will think we are lazy or inefficient if we don’t do everything we are asked. But other people cannot possibly know how busy you are, how much you dislike a particular task, or what other plans you have already made unless you tell them. Most people would feel badly to learn that you had done something for them that you really didn’t have the time for (e.g. writing a report that requires you to work all weekend) or that you really dislike doing (e.g. helping a friend move).

Final Tip: Although it is important to test skills out and use the trial and error process, we can learn a lot from observing others. Ask yourself who you feel comfortable interacting with – what do they do (lean forward, smile etc.). Try to identify some of the things that other people do that make you feel good interacting with them and then try doing those things yourself.

Recommended Readings

For more information on overcoming social anxiety, effective communication, and increasing assertiveness, see:

Antony, M. & Swinson, R. (2000). Shyness and Social Anxiety Workbook: Proven Techniques for Overcoming Your Fears. Oakland, CA: New Harbinger

Antony, M. (2004). 10 Simple Solutions to Shyness. Oakland, CA: New Harbinger

Burns, D. D. (1985). Intimate Connections. New York: Signet (Penguin Books)

McKay, M., Davis, M., & Fanning, P. (1995). Messages: The Communication Skills Book. Oakland, CA: New Harbinger

We can all become bogged down by negative thinking from time to time, such as calling ourselves mean names (e.g. “idiot”, “loser”), thinking no one likes us, expecting something terrible will happen, or believing that we can’t overcome something no matter how hard we try. This is normal. No one thinks positively all of the time, particularly when feeling anxious.

When we are anxious, we tend to see the world as a threatening and dangerous place. This reaction makes sense, because imagining the worst can help you to prepare for real danger, enabling you to protect yourself. For example, if you are home alone and you hear a strange scratching sound at the window, you might think it’s a burglar. If you believe that it’s a burglar, you will become very anxious and prepare yourself to either run out of the house, fight off an attack, or run to the phone and call for help. Although this anxious response is helpful if there actually is a burglar at the window, it is not so helpful if your thought was wrong: for example, it might be a tree branch scratching the window. In this case, your thoughts were wrong because there was no real danger.

The problem with thinking and acting as if there is danger when there is no real danger is that you feel unnecessarily anxious. Therefore, one effective strategy to manage your anxiety is to replace anxious, negative thinking with realistic thinking.

Realistic thinking means looking at all aspects of a situation (the positive, the negative and the neutral) before drawing conclusions. In other words, realistic thinking means looking at yourself, others and the world in a balanced and fair way.

How to Do It

Step 1: Pay attention to your self-talk

Thoughts are the things that we say to ourselves without speaking out loud (self-talk). We can have many thoughts every hour of the day. We all have our own way of thinking about things, and how we think has a big effect on how we feel. When we think that something bad will happen – such as being bitten by a dog – we feel anxious.

For example, imagine that you are out for a walk and you see a dog. If you think the dog is dangerous and will bite, you will feel scared. However, if you think the dog is cute, you will feel calm.

Often, we are unaware of our thoughts, but because they have such a big impact on how we feel, it is important to start paying attention to what we are saying to ourselves.

Step 2: Identify thoughts that lead to feelings of anxiety

It can take some time and practice to identify the specific thoughts that make you anxious, so here are some helpful tips:

Pay attention to your shifts in anxiety, no matter how small. When you notice yourself getting more anxious, that is the time to ask yourself:

“What am I thinking right now?”
“What is making me feel anxious?”
“What am I worried will happen?”
“What bad thing do I expect to happen?”

Some examples of “anxious” thoughts:

“What if I can’t do it?”
“I’m going to die of a heart attack.”
“People are going to laugh at me if I mess up during the presentation.”
“I’m going to go crazy if I can’t stop feeling so anxious.”
“Things are not going to work out.”
“I’m an idiot.”
“What if something bad happens to my child?”

Step 3: Challenge your “anxious” thinking

Thinking about something does not mean that the thought is true or that it will happen. For example, thinking that a dog will bite you does not mean that it will. Often, our thoughts are just guesses and not actual facts. Therefore, it is helpful to challenge your anxious thoughts, because they can make you feel like something bad will definitely happen, even when it is highly unlikely.

Sometimes, our anxiety is the result of falling into thinking traps. Thinking traps are unfair or overly negative ways of seeing things. Use the Thinking Traps Form to help you identify which traps you might have fallen into.

Here are some questions to help you challenge your anxious thoughts:

Am I falling into a thinking trap (e.g. catastrophizing or overestimating danger)?
What is the evidence that this thought is true? What is the evidence that this thought is not true?
Have I confused a thought with a fact?
What would I tell a friend if he/she had the same thought?
What would a friend say about my thought?
Am I 100% sure that ___________will happen?
How many times has __________happened before?
Is __________so important that my future depends on it?
What is the worst that could happen?
If it did happen, what can I do to cope with or handle it?
Is my judgment based on the way I feel instead of facts?
Am I confusing “possibility” with “certainty”? It may be possible, but is it likely?
Is this a hassle or a horror?

Here’s an example to help you challenge your negative thinking:

If you have an important interview tomorrow and have been feeling quite anxious about it, you may think: “I’m going to mess up on the interview tomorrow.”

To challenge this thought, you can ask yourself the following questions:

Am falling into a thinking trap?Yes, I have fallen into the trap of fortune-telling, predicting that things will turn out badly before the event even takes place. But I still feel like I’ll definitely mess up.
Am I basing my judgment on the way I “feel” instead of the “facts”?I might feel like I’m going to mess up, but there is no evidence to support it. I’m very qualified for the position. I have had interviews in the past and generally they have gone well.
Am I 100% sure that I will mess up?No, but what if I mess up this time?
Well, what’s the worst that could happen? If the worst did happen, what could I do to cope with it?The worst that could happen is that I don’t get a job I really wanted. It’ll be disappointing but it won’t be the end of the world. I can always ask for feedback to see whether there is anything I can do to improve my chances of getting another position similar to this one.

Use copies of the Realistic Thinking Form to regularly write down thoughts that make you anxious. Use the Challenging Negative Thinking handout to help you replace your anxious thoughts with more realistic ones.

Step 4: More on helpful and realistic ways of thinking

More tips on helpful thinking:

Tip #1: Coping statements. Try coming up with statements that remind you how you can cope with a situation. For example, “If I get anxious, I will try some calm breathing” ; “I just need to do my best” ; “People cannot tell when I am feeling anxious” ; “This has happened before and I know how to handle it” ; or “My anxiety won’t last forever”.

Tip #2: Positive self-statements. Regularly practise being “kind” to yourself (say positive things about yourself), rather than being overly self-critical. For example, instead of saying, “I will fail”, say something like, “I can do it”. Or, “I am not weak for having anxiety. Everyone experiences anxiety” ; “I’m not a loser if someone doesn’t like me. No one is liked by everyone!” ; or “I’m strong for challenging myself to face the things that scare me”.

Tip #3: Alternative balanced statements based on challenging negative thoughts. Once you’ve looked at the evidence or recognized that you’ve fallen into a thinking trap, come up with a more balanced thought.

Going back to the job interview example, a more balanced thought could be:

“There is a chance that I might not do well in tomorrow’s interview, but not performing perfectly on a job interview doesn’t mean I won’t get the job. Even if I don’t get this job, it doesn’t mean I will never get a job. I have always been able to find work.”

Hint: It can be tough to remember helpful thoughts or realistic coping statements when you are anxious. Try making up coping cards that include helpful statements. To make a coping card, write down your realistic thoughts on an index card or a piece of paper, and keep it with you (i.e. in your purse, wallet, or pocket). It can be helpful to read this card daily, just as a reminder.

We often want to make changes in our life but sometimes don’t know where to start. Goal setting can help you identify where you want to go and the steps needed to get there.

How To Do It

Step 1. Identify your goals

Take some time to think about the things that you would either like to do or that you want to change in your life. Try to identify some short-term goals (for example, things you would like to work on over the next couple of weeks or months), medium-term goals (for example, things you would like to be able to do in six months or a year from now) and long-term goals (for example, things you are hoping to accomplish in your life-time). Goals can be related to a variety of life areas such as:

Relationships (friends and family)
Career/School
Finances
Health
Lifestyle
Personal development

TIP: People who suffer from anxiety problems will often limit their lives because of anxiety. When trying to think of your goals, imagine a life without anxiety. What would you like to be able to do? You can use goal setting as a way to help you practice your tools for managing anxiety, or to move forward with your life as your anxiety becomes more manageable.

Goals should be:

1. Realistic

Make sure that your goals are realistic and attainable. If you set your goals too high, it will be too difficult to accomplish them and your motivation will suffer.

For example, if you have never worked out, expecting yourself to go to the gym for 1 hour 4 times a week is unrealistic. A more realistic goal would be to go to the gym once a week for 20 minutes. Your long term goal may be to go to the gym 4 times a week, but you need to start with smaller goals and work your way up to the long term goal.

TIP: People often have goals about never feeling anxious or making mistakes. However, these goals are unrealistic because it is normal to feel anxious, and everyone makes mistakes sometimes.

2. Concrete and Specific

You are far more likely to accomplish your goals if you make them concrete and specific rather than vague. If goals are too vague, it will be difficult to determine what steps you need to take to accomplish them. If your goals are specific, it will be easier to know when your goals have been met.

For example, “exercise more” is not a very good goal, because it is too vague. How will you know when you are exercising enough? How often do you want to exercise? For how long? “Exercise twice a week for 30 minutes” is a better goal because it is more specific – you will know exactly when you have completed it successfully.

Poor Examples of Goals	Good Examples of Goals
Eat Better Go back to school Meet new people Save money Travel Be less anxious Practice exposure exercises	Eat at least 1 piece of fruit each day Take a writing course at the community college in September Sign up for a hiking course and have a conversation with a new person on every hike Put $100 in my savings account each month Go on a trip to Paris for my 40th birthday Practice relaxation exercises once a day Complete exposure exercises weekdays between 7 and 9 pm.

KEY: Write down your goals! You are more likely to stay on top of your goals if you make a list of them.

Step 2. Break goals into smaller steps

Many goals can be broken down into smaller steps. This is especially true of medium and long term goals. For example, if your goal is to develop some friendships at work, an initial goal may be to ask 2 co-workers about their weekend plans on Friday afternoon. If your goal is to find a new job, a smaller goal may be to check the classified ads in the newspaper on Saturday.

Step 3. Identify obstacles

Once you have established a realistic and concrete goal, identify any obstacles that may be standing in the way of accomplishing your goal. For example, one of the obstacles for going to the gym may be finding childcare. So, if you have set a goal of going to the gym for 30 minutes after work on Wednesday, you will have to arrange for a babysitter.

Step 4. Schedule your goals

You are more likely to complete your goals if you are clear about what you are going to do and when you plan to do it.

For example, your goal may be to practice relaxation exercises for 15 minutes on Saturday morning around 10 a.m.
Use a day planner or calendar to help you remember to complete your goals.

TIP: It is important to be flexible. Sometimes things can get in the way of accomplishing your goals (for example, there is a rain storm on the day you wanted to go for a hike, or your son comes home sick from school the morning you were planning to practice driving). Be willing to come up with an alternative plan (e.g. go for a walk in an indoor mall or re-schedule your driving session for the next day).

Step 5. Carry out your goals

Now that you have picked a goal, you need to start taking the necessary steps to follow through with it. However, it can be hard to get started. In addition to writing down your goal (e.g. work out at the gym for 30 minutes after work on Wednesday), you can write out the steps that you will need to take to complete it (for example, call babysitter on Monday to arrange for her to pick up the kids after school on Wednesday, pack gym clothes on Tuesday evening, take gym clothes to work on Wednesday morning, head straight to the gym after work on Wednesday). You are more likely to take the steps needed to achieve your goal if you write them down first.

The key to achieving your goals is to just DO IT! Don’t wait for the motivation to come before you act; take action, and motivation will follow. For example, you may not feel motivated to start exercising, but once you have done it a few times you will start to feel more motivated to do it again.

If you were able to accomplish your goal, reward yourself.

It’s not easy to accomplish goals, so it’s important to reward yourself when you do accomplish them.
It may be helpful to use specific rewards as your motivation to achieve a goal. For example, plan to purchase a special gift for yourself (DVD, CD, book, treat) or engage in a fun activity (rent a movie, go to the movies, go out for lunch or dinner, plan a relaxing evening, watch your favorite television program) after you reach a goal.
Don’t forget the power of positive self-talk (e.g. “I did it!”).

If you had trouble completing your goal you may need to revise it.

Take a step back and see what got in the way. Retrace the steps for goal setting listed above.
Make sure your goal is realistic. If you set the goal too high, try to scale it back.
Make sure your goal is concrete and specific. If it was too vague, it may have been difficult to tell if you completed it.
Try to schedule your goal, because this will increase your chances of accomplishing it.
Find ways to get around obstacles.
Write down the steps that you need to take to accomplish your goal.

TIP: As you complete goals, check them off your list. This can be a helpful reminder of all that you have accomplished so far.

Helpful Hints

Start small. Making small changes can have a big impact on your life. Don’t try to do everything all at once. Instead, pick 1 or 2 goals to work on at a time.
Be patient. It can take time to meet goals, especially long term goals. Hang in there and stick with it!
Don’t think in “all or nothing” terms. No one completes all of their goals all of the time. You have not failed if you don’t accomplish all of your goals. Praise yourself for the goals you were able to meet and come up with a new plan for accomplishing the goals that you were unable to complete.

Our lifestyle can have a big impact on how we feel. When we don’t take care of ourselves, we can experience a number of problems, including sleep difficulties, fatigue, low energy, trouble concentrating, and increased tension and stress. These problems can leave us vulnerable to anxiety. Making healthy choices will help you feel better. Remember, the goal of developing a healthy lifestyle is to help us function at our best, not to eliminate anxiety (because anxiety plays an important adaptive role – without it we would not survive). (for more information on anxiety, see What is Anxiety?). Having a healthy lifestyle puts us in a better position for managing anxiety. Here are some ideas for building a healthy lifestyle.

Set a routineEstablish a routine by setting specific times for meals, work, housework, quiet time, and bedtime. We feel more secure when there is some predictability to our day. It also helps us get things done and reminds us to take time for ourselves. Having a routine can help you to set the stage to better manage your anxiety.

Regular exerciseRegular exercise can have a positive impact on both your emotional and physical health. In fact, exercise is one of the most powerful tools for managing stress and anxiety. However, it can be hard to start a regular exercise program. So, start small and work your way up. Aim for at least 20 minutes of physical exercise 3 to 4 times a week. You’ll be more likely to stick with a program if you choose something you enjoy (such as skiing, hiking, gardening, or dancing). Try joining a gym, signing up for an exercise class, or finding a workout buddy. Find little ways to increase your physical activity. For example, park further away from the door, or take the stairs. For ideas on how to set goals around exercise, see Guide to Goal Setting.
Eat healthyHaving a well-balanced and healthy diet can make you feel better. Eat consistently throughout the day and don’t skip meals. Your diet should include a variety of foods. Wondering how to eat healthier? Try to reduce your salt and sugar intake, eat more fruits and vegetables, and drink more water. Aim for 3 meals a day and 1 to 2 snacks. For more ideas on how to improve your diet talk to your doctor or a dietician.
Get a good night’s sleepSleep difficulties can contribute to anxiety problems and make it difficult to cope. Aim to get about 7 to 8 hours of sleep a night. However, this is just an estimate. People differ on how much sleep they need and this amount can change with age. If you are experiencing sleep problems talk to your doctor. For more information on dealing with sleep problems see Getting a Good Night’s Sleep.
Establish social supportsIt is important to have people in your life that you can count on. It helps to be able to talk to a friend when you have had a bad day or are struggling with a problem. Having a good social network has been linked to greater well-being. Having at least 1 good supportive friend can make a difference. Unfortunately, it can be hard to make friends. For more information, see Self-Help Strategies for Social Anxiety (Meeting New People) and Effective Communication – Improving Your Social Skills.
Learn to relaxUsing relaxation strategies can help lower your overall tension and stress levels. However, relaxation is more than just sitting on the couch watching television. What makes a difference is “deep” relaxation, which is the opposite of what your body experiences when it is under stress. For more information about various relaxation exercises, seeHow to do Calm Breathing and How to do Progressive Muscle Relaxation.
Manage your timeLearning to manage your time more effectively can reduce stress. Use a day planner to schedule your activities. This will help you see if you’re taking on too much, and help you make time for the things you need to do. Remember to schedule some time for relaxation and fun activities each day.
Reduce stimulants Excessive caffeine can lead to sleep problems and heightened anxiety. Try to reduce your caffeine intake. This includes coffee, some teas, soda, and chocolate. If you drink a lot of caffeinated beverages, it’s better to gradually reduce the amount of caffeine that you have every day. Smoking is also a strong stimulant. In addition to the health benefits, quitting smoking may also leave you less prone to anxiety.
Avoid alcohol and drugs It is NEVER a good idea to use alcohol or drugs to help you cope with anxiety – this just leads to more problems. If you have problems with anxiety, try to avoid using drugs and alcohol as a way to cope with negative feelings. If you think that you may have a problem with drugs or alcohol, talk to your doctor.
Get a check-up Make sure you are taking care of your body. See a doctor for regular check-ups.
Solve problemsProblems are a common source of stress and can contribute to anxiety. Therefore, it is important to start identifying and dealing with your problems. However, it can be hard to know which problems to tackle and exactly how to go about solving them. For more information, see How to Solve Daily Life Problems.
Reduce stressSometimes life’s demands become too much. Stress can have a negative impact on your health. Look for ways to reduce stress. Deal with problems, lean on supports, and take time for self-care. For instance, plan some time for yourself each day to read a book, go for a walk, watch a favorite TV program, or relax. You can also reduce stress by giving yourself a little extra time to get to places so that you’re not rushing. Try giving yourself an extra 5 minutes – it can make a big difference!

HELPFUL HINTS:

Start Small: Making small changes can have a large impact on your life. Don’t try to do everything all at once. Instead, pick 1 or 2 things and try them consistently. When you’re ready, try adding a new strategy.
Set Goals: Identify some things you want to work on and set some realistic goals. For more information, see Guide for Goal Setting.
Be Patient: These strategies can take time to have a positive effect. Hang in there and stick with it!

Thought-action fusion. People with this kind of interpretation think that their unwanted or “bad” thoughts:
- - Increase the likelihood of the “bad thought” (for example, a loved one being in a plane crash) actually happening.
  - Are just as wrong as “bad” deeds. For example, having a thought about beating up your friendly elderly neighbour for no reason is just as bad as actually committing the act.
Inflated responsibility. This obsession involves overestimating or exaggerating the amount of responsibility you have over the outcome of an event. For example, “If I do not wash my hands frequently and carefully, it will be entirely my fault if anyone in my family gets a cold or becomes sick.”
Overestimation of threat. People with this interpretation believe that their worst fears are extremely likely to happen. For example, “If I don’t wash my hands after touching this door knob, I will end up with HIV/AIDS and die.”
Mental control failure. Many people with obsessive compulsive disorder (OCD) also believe that they should be able to control their thoughts at all times, and that not being able to completely control their thoughts will lead to terrible consequences. For example, “If I don’t control all the thoughts in my head, I will go crazy or have a nervous breakdown”. Some people with this interpretation think, “If I can’t control my thoughts, then…”:
- - The thought must be meaningful (e.g. “Why else do I keep on having them?”)
  - The thought shows a flaw in my character (e.g. “I must be weak; otherwise I would be able to control my thoughts.”)
  - I will also lose control over my behaviour. For example, “If I don’t stop having the thought of stabbing my partner, I will end up doing it and killing him.”
Perfectionism. This obsession is the belief that there is 1 “perfect” way to do everything and that anything less than perfect is totally unacceptable. See the How to Overcome Perfectionism section for more information about perfectionism and how to be more flexible with your standards.
Intolerance of uncertainty. This obsession involves the belief that you need 100% certainty that something bad has not or will not happen in order to feel “safe” or continue with your daily activities. See the How to Tolerate Uncertainty section for more information about how to increase your comfort with uncertainty.

For the people who love and care about you, seeing you struggle with anxiety every day can be very difficult. Friends and family usually want to help you to deal with your anxiety. However, sometimes they inadvertently do things that are not so helpful.

What Friends and Family do that is NOT Helpful

Your friends and family are often trying their best to help. The following list includes things that they do that might (inadvertently) be maintaining your fears and anxiety in the long-term.

Following the rules

Some people with anxiety have set up their whole lives in such a way that they can avoid situations that cause anxiety. For example, some people will not go into certain situations without a companion or a “safe person” with them. Others will have “rules” about what to do at home. For example, an anxious person might have everyone in the house wash a certain way or dictate when and how to answer the phone.
Although it might seem helpful to have your family assist you in coping with your anxiety, what they are actually doing when they follow your rules is helping you to AVOID anxiety.

REMEMBER: Avoiding anxiety only works in the short-term. Facing your anxiety is the only way to effectively manage it in the long-term.

Keeping you out of danger

Because it can be troubling for friends and family to see you feeling anxious, they can sometimes “keep you out of danger” before you are even in an anxious situation. For example, if you go to a movie with a family member, they might automatically choose seats in the back and near the exit so that you can “escape” if you are feeling anxious. Or, a loved one might pull you out of a social situation as soon as you look even a bit uncomfortable.
Once again, it is clear that friends and family are trying to help. But the message that they are actually sending when they do this is that anxiety is dangerous and needs to be avoided at all costs.

REMEMBER: Anxiety is uncomfortable and sometimes unpleasant, but it is not dangerous. It is a normal and necessary system in the body.

Pushing too much

Not all loved ones try to keep you out of anxious situations. More and more people are starting to hear about the benefits of facing your fears. Because of this, some friends and family will try to push you into anxious situations before you are ready or without telling you first. For example, if you are afraid of dogs they might take you to a dog park without telling you, or come to your house with a dog and ask you to pet it.
Although trying to help you face your fears is a good thing, when sprung on you suddenly, it that can feel very scary and overwhelming. It is a bit like the old idea of learning how to swim by being thrown in a lake: this won’t help you learn how to swim, it will only make you scared of water and probably distrusting of the person who pushed you. Loved ones who push too much are actually making the world a scary place for you, and are going to cause you to distrust them.

REMEMBER: Although it is important for you to face your fears, it is best to do it gradually and at your own pace.

Helpful Strategies for Friends and Family

There are several things that friends and family can do to help.

Learning about anxiety

When struggling with anxiety, an important first step for you is to learn about what anxiety is and the strategies that are helpful in the long run. If family and friends are going to help you, they need to know this information too.
Teach them what you know about anxiety and encourage them to find out more information about cognitive behavioural therapy (CBT) and effective strategies for managing anxiety.

REMEMBER: Your friends and family are more likely to be able to help you if they understand what you are doing to manage your anxiety.

Practising skills with others

An important part of managing your anxiety is learning new and more effective ways of thinking and behaving in anxious situations. In order to do this, you need to practise the skills that you have learned. Friends and family can be a great help with this.
Have your loved ones practise with you. For example, if you are learning CBT, do it with others. If you are going to face your fears, you can bring someone along at first. You can even include your family and friends in your exposure ladders. For example, if you are facing a fear of going into a crowded mall, you might first go with a loved one before trying to go alone.

REMEMBER: It can be much easier to practise your skills when someone is doing them with you.

Avoiding avoidance/ giving reminders

Since it is not helpful for your loved ones to encourage you to avoid the things that make you feel anxious, they can instead encourage you to use your CBT skills when you are feeling this way.
Have your friends and family remind you that you are feeling anxious, and that it might be a good time to think about using some of your strategies. For example, if you are in an anxious situation, loved ones can remind you to do some calm breathing or to come up with a coping thought.

REMEMBER: Although avoidance reduces your anxiety in the short-term, it doesn’t work in the long-term. Using your skills in anxious situations is the best way to cope with anxiety in the long run.

Remembering not to push

Although you want your loved ones to encourage you to master your anxiety, it is important that you do so at your own pace. If you enter an anxious situation before you feel ready, you are probably going to feel overwhelmed and end up escaping the situation.
Tell your family and friends that they need to respect the pace that you are setting for dealing with your anxiety. They can encourage you to try new things but they should not force you into new situations.

REMEMBER: Exposure works best if it is done gradually, starting small and working your way up.

A final point…
THE FINE LINE BETWEEN ENCOURAGING AND NOT PUSHINGIt might seem confusing to your loved ones when they are told that they should not encourage avoidance but that they also should not push you into anxious situations.

So when is it not enough and when is it too much?

As a general rule, family and friends are most helpful when they give you a gentle nudge to face your fears but will stop pushing if you say that a situation is too scary. A good idea is to have family and friends help you think about what you can do to face your fears instead of the situation that is too scary for you.

Remember: If something is too difficult, there is always a way to make it easier!

For example, if a loved one nudges you to go pet a dog and you are too afraid of dogs to do it, then you can both think about what you can do instead. You might go for a walk together near a dog park, but without actually petting one of the dogs.

Most people feel a bit uneasy when they see blood or have to get a needle. However, for some people, seeing blood or needles causes them to faint or to feel like they will faint. It is very rare to actually faint from anxiety, unless you have this problem. If you tend to faint when you get an injection or have blood drawn you can benefit from learning a simple technique that will help you prevent fainting or speed up the recovery time if you do faint.

Why do Some People Faint at the Sight of Blood or a Needle?

Fainting is caused by a sudden drop in your heart rate or blood pressure. When we are anxious, our heart rate and blood pressure actually go up. This is why it is so rare to faint when you are feeling anxious. However, some people with a fear of blood or needles experience an initial increase and then a sudden drop in their blood pressure, which can result in fainting. This drop in blood pressure is called the vasovagal response. Only a small minority of people have this response at the sight of blood or needles. The good news is, if you have this problem there is a way to prevent it and keep yourself from fainting.

In most cases, fainting is harmless.The sudden drop in blood pressure that results from the vasovagal response is not dangerous or life-threatening.

However, it is important that you discuss your fainting with a doctor before using this technique or exposing yourself to situations (such as needles or blood) that could cause fainting.

The Applied Tension Technique

The Applied Tension Technique (The Applied Tension Technique was developed by Lars-Göran Öst) is a strategy developed to help prevent fainting or help people recover faster if they do faint. The technique involves tensing the muscles in your body, which then raises your blood pressure. If your blood pressure increases, you are less likely to faint.

How to Do It

Sit in a comfortable chair and tense the muscles in your arms, legs and trunk forabout 10 to 15 seconds. You should hold the tension until you start to feel a warm sensation in the head. Then, relax your body for 20 to 30 seconds. Repeat 5 times.

TIP: When you relax your muscles after tensing them, the goal is not to become completely relaxed, as this will cause your blood pressure to drop. Rather, the goal is to let you body return to a normal state (not overly tense or completely relaxed).

Practicing

It is important that you practice this strategy several times a day for at least a week.

Using the Applied Tension Technique with Exposure Exercises

After you have practiced this technique for at least a week, you can start using this strategy when doing exposure exercises to blood and needles. See modules on Specific Phobia and Facing Your Fears – Exposure for more information.

Helpful Tips:

Speedy Recovery: If you do faint, you can speed up your recovery by lying down and elevating your feet.
Tense & Relax: If you tense your arm when you are receiving a needle, it can be more painful. Try to relax the arm that will be receiving the needle, while tensing the other parts of your body. However, since this can be difficult to do, it’s important to practice before going to get an injection. Alternatively, you can use the tension technique before and after getting a injection but try to release the tension in your body when you actually get the needle.
Warning: If you develop a headache when trying the applied tension technique, try to reduce the level of tension or the frequency of practice sessions.
Warning Signs: It can be helpful to learn to recognize the early signs of your blood pressure dropping, such as feelings of lightheadedness. Try to use the tension technique as soon as you start to experience these sensations.
Practice: Even though this strategy sounds simple, it takes practice to be helpful.

CBT, or Cognitive-Behavioural Therapy, is a psychological treatment that was developed through scientific research. That is, all of the components of CBT have been tested by researchers to determine whether they are effective and that they do what they are intended to do.

Research has shown that CBT is one of the most effective treatments for the management of anxiety. The good news is that although it is best done with a trained CBT therapist, you can apply CBT principles at home to manage your own anxiety and conquer your fears.

What are the Principles of CBT?

CBT involves learning new skills to manage your symptoms. It teaches you new ways of thinking and behaving that can help you get control over your anxiety in the long-run. There are a few principles that are important to understand when using CBT.

1. CBT focuses on the here and now

An important principle of CBT is that treatment involves dealing with the symptoms that you are struggling with right now, rather than focusing on the cause of your problem. Although it can be interesting to understand how your anxiety developed, just knowing why you have anxiety problems is often not enough to help you manage your anxiety.

Here is an example: Imagine that you are terrified of dogs. Every time you see one, you run the other way because you are convinced that all dogs are vicious beasts that will bite you. Now, if you wanted to understand why you are so afraid of dogs, you might eventually find out that you were bitten by a dog when you were a child, which is no doubt the causeof your fear of dogs.Here’s the problem: Knowing the cause does not change the fact that you are terrified of dogs, running away from them, and thinking of them as vicious beasts that bite.

2. CBT emphasizes the importance of homework

Whether you are receiving CBT from a trained therapist or you are using self-help CBT techniques, homework is a key component. Doing homework for CBT basically means that from week to week, you will need to practise the new skills that you are learning and apply them to your daily life. And like the homework that you were given in school, you need to practise those skills every day.

Why is homework so important?

Unless you practice the new strategies you’ve learned to manage anxiety, you will not use them very well, and you will probably forget to use them when you need them most: when you are feeling very anxious.

Learning new ways to manage anxiety is a little like developing a new healthy habit. If, for example, you wanted to start exercising regularly, you would want to fit in a new exercise routine into your schedule. It would be difficult at first, but if you kept at it, that new routine would become a habit, and eventually a part of your regular activities. The same is true with CBT skills: if you practise them every day, they will become a part of your daily routine.

The good news is that the more you use your CBT skills, the easier it gets, and the better you will become at managing your anxiety.

What to Expect if You See a CBT Therapist

CBT is structured and educationalTreatment sessions in CBT involve learning new ways to think about and understand your symptoms. Because of this, sessions are structured so that you are usually reviewing the homework you did, learning new information and skills, and then developing a new homework assignment for the next session.
CBT is collaborativeBecause you are learning new skills in CBT, therapy is very active. Both you and your therapist will be working on helping you to understand your symptoms and ways to manage them. You can expect to participate both in and out of session in order to see positive changes.
KEEP IN MIND: When it comes to CBT, you get out of it what you put in. If you don’t put your best effort into managing your own anxiety, you probably won’t get as much benefit from CBT as you could.
CBT is time-limitedPeople who go to see a CBT therapist to help them with their anxiety will usually have between 8 to 20 sessions. CBT is not supposed to be a life-long process. Rather, you are learning to become your own therapist. Once you have learned new skills, had a chance to master them and see positive changes in your life, it will be time for you to leave therapy and continue managing your anxiety on your own.

What will I learn in CBT?

CBT involves learning how to change your thoughts (also called cognitions) and your actions (or behaviours), which is why it is called cognitive-behavioural therapy. Why is this important? Because in any given situation, you will have thoughts and feelings about it, and behave in a certain way. These thoughts, feelings and actions all interact and influence each other. The best way to understand this is to think about them as a triangle:

Returning to our example of a fear of dogs, imagine a situation where you are walking down the street and you see a dog. You might expect to feel afraid, to think that the dog will bite, and to run away or avoid the dog in some way. In our triangle, it would look like this:

However, if we imagine that you have a friend who is not afraid of dogs and actually likes them very much, your friend’s thoughts, feelings and actions might be very different:

REMEMBER: One thing to notice in these 2 examples is that the situation did not change: but if you change your thoughts, then your feelings and actions change as well.If we return to the first example, you might be able to reduce your fear of dogs if you either:

Change your behaviour

By using exposure, you could gradually approach dogs rather than avoid them. Over time, your fear of dogs would be reduced and you would probably learn that not all dogs bite. Exposure is one of the best tools at your disposal to face your fears and manage your anxiety in the long run (see Facing Your Fears – Exposure).

Change your thoughts (cognitions)

You might also change the triangle if you were able to challenge the thought that all dogs bite. For example, you might tell yourself that if all dogs were vicious and bit people, no one would have them as pets. When we feel anxious, our thinking tends to be overly negative, because it is completely focused on danger and threat: we don’t always see the whole picture.

If you are afraid of dogs, for example, when you see a dog you might only be thinking about how sharp his teeth look and not about whether he is on a leash or if his tail is wagging. Learning to take a closer look at your thoughts, and coming up with more balanced and realistic thoughts, is another important tool for managing your anxiety (see Realistic Thinking for more information).

Key Points to Remember:

CBT, or Cognitive-Behavioural Therapy, is based on research – so we know it works!
CBT teaches you new ways of thinking and behaving.
Thoughts, feelings and behaviours are inter-connected, so if you change 1, it has an effect on the other 2.
If you change the way you think and behave, you can also change the way you feel.

Exposure Exercises for Panic Disorder (Examples)

Facing Fears (Worksheet / Examples)

Fear Ladder (Worksheet / Examples)

Obsession Challenging (Worksheet / Examples)

Obssessive Fear Monitoring (Worksheet)

Realistic Thinking (Worksheet / Examples)

Sleep Diary (Worksheet / Examples)

Thinking Traps (Examples)

Thought Challenging (Worksheet)

Worry Diary (Worksheet)

Self Help – Managing Anxiety: Getting Started

Welcome!

Do you have mild to moderate anxiety?

Do you have a diagnosed (or suspected) anxiety-related disorder?

What Is Anxiety?

The Facts

Learning the Facts About Anxiety

What Happens to Your Body When You Are Anxious?

More About How Anxiety Works

Recognizing physical symptoms of anxiety

Recognizing anxious thoughts

Recognizing anxious behaviours

Nine Anxiety-Related Disorders

9 Anxiety-Related Disorders

Complete Home Toolkit

Self-Help Strategies for GAD

Step 1: Learning About Anxiety and GAD

Step 2: Identifying and Recognizing Your Worry

Step 3: Classifying Your Worries

Step 4: Building Your Worry Management Toolbox

How to Write a Worry Script

Why is a Worry Script Helpful?

The good news

One final point

Step 5: Building on Bravery

Tools

Calm Breathing

What is “Calm breathing”?

Why is Calm Breathing Important?

How to Do Calm Breathing

Challenge Negative Thinking

Thought Challenging – Worksheet

How to Overcome Perfectionism

Here are the Steps to Help You Overcome Perfectionism

Step 1: Learning to recognize perfectionism

Step 2: Tools to overcome perfectionism

Step 3: Reward yourself

Facing your Fears: Exposure

How To Do It

Step 1. Make a list

Step 2. Build a fear ladder

Step 3. Facing fears (exposure)

Step 4. Practice

Step 5. Reward brave behaviour

How to do Progressive Muscle Relaxation

Getting Ready

How to do Progressive Relaxation

The tension – relaxation response

The different muscle groups

Quick tense and relax

Release only

Effective Communication – Improving your Social Skills

Why Are Communication Skills Important?

Nonverbal Communication

Step 1: Identifying your trouble spots

Step 2: Experiment with and practice non-verbal skills

Conversation Skills

Step 1: Identifying your trouble spots

Step 2: Experiment with and practice your conversation skills

Assertiveness

Step 1: Identifying your trouble spots

Step 2: Practice your new assertiveness skill

Barriers to Behaving Assertively – Myths about Assertiveness

Realistic Thinking

How to Do It

Step 1: Pay attention to your self-talk

Step 2: Identify thoughts that lead to feelings of anxiety

Step 3: Challenge your “anxious” thinking

Step 4: More on helpful and realistic ways of thinking

Guide for Goal Setting

How To Do It

Step 1. Identify your goals

Step 2. Break goals into smaller steps

Step 3. Identify obstacles

Step 4. Schedule your goals

Step 5. Carry out your goals

Tips for Healthy Living

Unhelpful Interpretations of Obsessions

How Friends and Family can Help

What Friends and Family do that is NOT Helpful