Creating Calm: 3A Toolkit for Managing Stress and Anxiety- Adult Edition by megkapil

Creating Calm 3A Toolkit for Managing Stress and Anxiety Ad Adult Edition

Meg Kapil ma, ccc-s, rcc

CONTENTS PART ONE: THE ESSENTIALS

CHAPTER 1: What is Worry?

CHAPTER 2: Your Foundation

CHAPTER 3: The 3A Toolkit Plan for Managing Worry

CHAPTER 4: Strategies for Body Regulation

CHAPTER 5: Strategies for Helpful Thinking

CHAPTER 6: The Debrief—Rewind, Reflect, Rewrite and Replay

CHAPTER 7: From Avoidance to Approach

PART TWO: THE EXTRAS 63

CHAPTER 8: Relationship Strategies

CHAPTER 9: Strategies to Manage Emotion and Memory

PART THREE: WHAT’S NEXT? 71

CHAPTER 10: Planning Ahead

REFERENCES 78

Creating Calm The 3A Toolkit Approach to Managing Stress and Anxiety ADULT EDITION

PART ONE: THE ESSENTIALS

Welcome to the Creating Calm: 3A Toolkit for Managing Stress and Anxiety (Adult Edition) workbook! This workbook will explore the nature of anxiety, including helpful information about how your brain and body are involved in how you experience anxiety. You will also learn about the 3A Toolkit approach to managing stress and anxiety. This includes walking through the three sections of the 3A Toolkit: Awareness, Assign a Label, and Action. Finally, you will build your own personal 3A Toolkit to help you best manage your anxiety. I look forward to taking this journey with you as you develop your own personal toolkit for managing stress and anxiety. Even more important, I’m excited for you to feel like you are making choices in your life instead of letting stress and anxiety make the choices for you. Just imagine what will be different. There are three parts to this workbook. Part One: The Essentials includes information and strategies that are important for everyone who is dealing with stress and anxiety. The workbook starts with an overview of the nature of stress and anxiety. The is followed by a discussion of what is called “Your Foundation”. These are common factors that boost overall mental health and are important for increasing your wellbeing and giving you the resources you need to continue to tackle stress and anxiety. Next, an overview of the 3A Toolkit approach for managing stress and anxiety is provided. This is followed by a more thorough explanation of strategies to regulate your body’s response to stress and anxiety as well as strategies to address your thinking. The final two chapters in Part One: The Essentials takes you through a critical process of reflection that will boost your chances of successfully managing anxiety, the Debrief. In The Debrief, you will learn how to draw from past experiences of being anxious and use these as opportunities to apply what you are learning in this workbook and modify your perception of how you manage your anxiety. This important process helps you to understand and transform previous anxious experiences as well as prepare for how to manage present and future stress and anxiety. The final chapter in Part One: The Essentials will help you address the issue of avoidance, which is all too

common with anxiety. You will have the opportunity to examine behaviours that may be keeping you stuck in an anxious experience and create new and healthier patterns. For many people, and for a variety of different reasons, challenges with managing stress and anxiety can be pervasive and persistent and really hard to change. This may be because of how long you have been struggling with anxiety, this may be because you have had some really bad experiences in your life, and it may be because you are also dealing with several other challenges at the same time as being anxious. If you relate to this, then Part Two: The Extras of this workbook is for you. Part Two: The Extras provides an additional focus on relationships, emotion, and memory as important areas to focus on for your wellbeing. While not everyone will need to draw from the information and strategies in Part Two: The Extras to manage your anxiety, you will still benefit from reading through these chapters. Finally, Part Three: Whatâ&#x20AC;&#x2122;s Next contains helpful information for everyone in terms of looking forward to the road ahead. You will have worked very hard to get to this point. This final section will help you to keep the positive changes going. I am really looking forward to accompanying you as you tackle this important process of learning to manage stress and anxiety. More importantly, I am excited for you to gain confidence in your own ability to manage your stress and anxiety. Just imagine how differently you will feel, think, and act when your anxiety is taking up less of your internal space!

Chapter 1: What is Worry? “Worrying is carrying tomorrow’s load with today’s strength—carrying two days at once. It is moving into tomorrow ahead of time. Worrying doesn’t empty tomorrow of its sorrow, it empties today of its strength.” — Corrie Ten Boom

You know this presentation is important and you have put a lot of time into preparing well. None of that matters now though. Just like last time, your thoughts are all jumbled up, your heart is racing, you are having a hard time catching your breath, your palms are sweaty, you know that soon you will start to feel nauseous. That unpleasant voice in your head snaps “I’m such an idiot, what is wrong with me, why am I the only one who can’t do this, this is going to be a disaster”. Even when your friend tells you “you’re going to do a great job” you barely hear them and know they don’t really mean it, they are just trying to be nice. If you have ever faced stress or anxiety (which is pretty much everybody), you’ll notice that the example above captures some of the most recognizable aspects of anxiety including changes in your thinking, the emotions you feel, the sensations in your body, and how you relate to others. Anxiety is an all too common mental health struggle that affects people no matter their age, gender, financial background, culture, geographic location, and more. Anxiety interferes with how you want to live, with how well you perform, and with how you think and feel about yourself. Imagine how you and your life would be different if anxiety was not there, lurking and threatening, reminding you of everything out there in the world you should be afraid of, including yourself. There’s a lot of information out there about anxiety, what it is, what causes it, what to do about it. For some, this mountain of information can add to feeling overwhelmed instead of helping find the solution. Part of the challenge is much of available the information is missing the rationale of why to use a particular strategy and when to use it. In this workbook, an integrative framework will be used to provide you with a clear understanding of what anxiety is and what to do about it. You will learn how and when to use a range of strategies that will shift anxious thinking, help you to calm your body, and consider how you relate to others and yourself. We will be working together to help you build a personal toolkit to help you shrink stress and anxiety in your life. Defining Stress and Anxiety In very simple terms, a stressor is anything that requires us to burn energy in order to keep internal systems running smoothly. The experience of stress can be both positive and negative, overt or hidden, physiological and psychological, internal or external, self-imposed, or forced upon us. When we are talking about stress in our everyday lives though, we usually think about only the negative experience of stress.

How we relate to that stress, the meaning we assign to it, will be a focus of the 3A Toolkit approach. As I won’t actually meet with you and talk to you about the circumstances in your life that can contribute to stress, the focus in this workbook will only be on your response to stress and anxiety. Sometimes you can also really benefit from changes to your circumstances, I just won’t have enough information about your life to advise you about that here. In this workbook, we will consider stress and anxiety on a continuum and may even use the terms interchangeably. Stress is typically in response to a specific circumstance while anxiety is a full body, cognitive and emotional response to perceptions of threat or danger in the internal or external environment that causes disturbance in several domains. While stress is challenging to manage, it is often short term and dissipates when the situation changes or the stressor is removed.

STRESS A stressor is anything that requires us to burn energy in order to keep internal systems running smoothly. The experience of stress can be both positive and negative, overt or hidden, physiological and psychological, internal or external, self-imposed, or forced upon us. Stress is typically in response to a specific circumstance. ANXIETY A full body, cognitive and emotional response to perceptions of threat or danger in the internal or external environment that causes disturbance in several domains including: behaviour, emotion, cognition, social, and physiological. WORRY

Another term to describe anxious feelings Anxiety represents your experience when that is typically milder than anxiety. Worry is you no longer feel like you can manage easily. usually characterized by ruminating thoughts You may notice negative changes in various about something that is anticipated. aspects of your life such as work, school, relationships, and other activities. Also, it is always not clear what is the cause of the anxiety. Whether we are talking about stress or anxiety, you will notice similar thinking patterns and similar physical sensations. This workbook will help you with both. Worry is another term you have likely heard of and can also be used alongside stress and anxiety. Worry is typically milder than anxiety and is usually characterized by ruminating thoughts about something that is anticipated. In this workbook, I refer mostly to stress and anxiety but the information here applies to worry also. It is important to note that anxiety is a diagnostic label that typically follows an assessment by a qualified helping professional such as a psychiatrist, psychologist, or doctor. It is a good idea to seek professional support if you are wondering if you have anxiety. You may still experience anxiety even if you have not had a formal diagnosis. In this workbook, I will use the words worry and anxiety interchangeably as I don’t know if you have a diagnosis of anxiety or not. In any case, the material will help you manage better whether you are dealing with stress, worry, or anxiety. I’m really looking forward to you learning more about yourself and gaining confidence to shrink your stress or anxiety!

For more information regarding anxiety see https://anxietycanada.com

Have a look at the table below and write down the changes you experience in response to stress, worry, or anxiety in the following categories:

Changes That Occur When You Experience Stress, Worry, or Anxiety

BEHAVIOUR

EMOTION

COGNITION

SOCIAL/ RELATIONAL

PHYSIOLOGY (BODY)

PHYSIOLOGY (BRAIN)

Keeping in mind that everyone will have different answers in the table above, here are some examples of changes you might notice in response to stress, worry, or anxiety:

Examples of Changes That Occur When You Experience Stress, Worry, or Anxiety

BEHAVIOUR

Avoidance of tasks, people, internal experience Withdrawal from activities Jumpy body Excess energy Fear Worry Frustration Panic

Overwhelmed Dread Self-doubt

COGNITION

Negative thoughts Rumination Fixated on ‘what if’ and ‘why’

Over-identification with perceptions of threat

SOCIAL/ RELATIONAL

Withdrawal from relationships Negative view of self

PHYSIOLOGY (BODY)

Increased heart rate Breathing is shallow and fast

EMOTION

PHYSIOLOGY (BRAIN)

Change in blood flow Increased cortisol Stomach discomfort

Activated brainstem Activated amygdala Lack of neural integration

The above examples may not be exactly what happens when you are worried, or some of the things might happen to you but not others. While there are similar things that happen when all of us get worried, each of us has our own unique experience of worry. What is important is that you are aware of how worry impacts you in each of the categories listed in the table above.

From filling in the chart, you can see all the different ways anxiety impacts you. Although everyone is unique, there are many common elements when we are talking about anxiety. Now let’s discover more about anxiety by learning about what happens in your brain and your body. Feelings of stress or anxiety don’t tend to go away without you making some kind of change either by changing the situation or by changing how you respond to the situation. As I don’t have the details of your life and the situations that are contributing to your anxiety, the focus of this workbook is on changing how you respond to the situation. Even if you are not able to influence the situation itself, there is always something you can do to respond differently.

THE 3A TOOLKIT APPROACH It helps to know a bit about the ideas that have shaped this workbook and the 3A Toolkit approach. The 3A Toolkit approach to managing stress and anxiety draws mostly from the field of Interpersonal Neurobiology (IPNB) (Siegel, 2014). This approach extracts wisdom for many different disciplines of science to weave a picture of human experience and the process of change across the lifespan. The IPNB perspective incorporates objective scientific inquiry and more subjective reflections regarding human knowing with the intention of alleviating suffering and supporting well-being. The IPNB approach is really helpful, especially when we want to answer questions that are important in the understanding of anxiety such as how we define the mind and wellness. What is the Mind? You may not have started this workbook with a burning desire to contemplate is the nature of the mind before you address your anxiety, but I will explain why it is helpful to do so. ‘Mind’ is a term that’s used often and in many contexts, but often without a clear meaning. Think about times you might have said “I’m losing my mind”, “are you out of your mind?”, “keep that in mind” and of course all the times we talk about shaping young minds at school, and all the times we talk about wanting a healthy mind. Considering these examples, how do you define the mind? MY DEFINITION OF THE MIND

Not to worry if you had a hard time coming up with a definition, you’re not the only one who found this hard. In his book Mind, researcher Daniel Siegel talks about gathering many experts from a whole range of different areas of study. He found that there was no clear definition of mind. It is hard to recover from stress and anxiety and work towards a healthy mind when you are not sure what it is! From Daniel Siegel (2012) and the field of IPNB, the definition of the mind that emerged was that the mind is a “process that regulates the flow of energy and information within our bodies and within our relationships, an emergent and self-organizing process that gives rise to our mental processes such as emotion, thinking, and memory. Subjective experience, awareness, and an embodied and relational process that regulates the flow of energy and information are fundamental and interdependent facets of mind.” (page 1). At first glance, this definition may seem hard to wrap your “mind’ around, but it highlights key ideas that are important for us here in our quest to manage anxiety. This definition shows that the mind is not an object, but is rather a process of energy and information flow. In addition, the definition includes not just the brain but also the body, and situates the mind within relationships. These ideas will help us to create a toolbox for managing stress and anxiety and moving towards having a healthy mind, especially now that you know what it is! What is Wellness? Challenges with stress, worry, and anxiety interfere with wellness. A goal of this workbook is to help improve your wellness. We defined mind above and now we will address wellness, another very ambiguous term. It’s challenging to arrive at wellness when we are not sure what it is. For the purpose of this workbook and our focus on anxiety, I am defining wellness as a state that is experienced when you are integrated and regulated. Integration Integration refers to the differentiation and linkage of differentiated parts. In other words, we need to know how the different parts of our brains and bodies work and attempt to link these together. In the 3A Toolkit approach, we will focus on integration between the main areas of the brain, between the brain and the body, and in relationships. Among other things, an integrated brain is more receptive to learning and appropriate behaviour. Thus, a key goal in the 3A Toolkit approach is to foster integration. We will look at how to create better integration in the brain and the body. Regulation Regulation refers to being able to manage or ‘regulate’ thinking, emotions, and physiological reactions. Developing the capacity to regulate your responses in these different areas is a main focus of the 3A Toolkit approach. Consider the example from the beginning of the workbook about someone who is anxious about public speaking. For the person in this example, they will need to learn to regulate their thinking so they can shift from negative to more positive thinking. They will learn to regulate their emotional response so they can grow positive emotion such as confidence.They will also need to regulate their physiological arousal, such as breathing and heart rate, so they can feel more calm. And they will learn to regulate their behaviour so they don’t avoid public speaking altogether. Through improving ‘regulation’ of thinking, emotions, physiological responses, and behavior, the person will be able to manage their anxiety about public speaking and likely feel much better as a result! © 2020, MEG KAPIL, ALL RIGHTS RESERVED

What Happens in Your Brain When You are Worried? It is helpful to have some information about how your brain works so you can better understand what is going on when you are worried and also know what to do in order to feel better. The brain is really complex, so we will only talk about the parts that are important to understanding worry. The three main parts of the brain we will talk about are the reptile, mammal, and human brain. Together these are called the triune brain and all three of these parts play a role in anxiety. This a very simplified version of the brain, my apologies to all the neuroscientists out there. In reality, the brain is far more complex and interconnected but the triune brain is a really great model to help us understand worry and develop strategies for managing it (Paul McLean, 1960).

THE TRIUNE BRAIN:

HUMAN MAMMAL REPTILE

REPTILIAN BRAIN (Brainstem and Cerebellum) The first part of the triune brain we will talk about is the reptilian brain. This is also the most ancient part of the brain in terms of evolution and the only part of the brain to be fully developed when you are born. It is responsible for all the functions we donâ&#x20AC;&#x2122;t think about (or automatic functions) such as breathing, digestion, heart rate and reflexes. This part of the brain also plays a big role in your alarm response when you are afraid, worried or anxious. This response is often called fight, flight, or freeze. When activated, this part of your brain signals your body to be ready for danger; more about how the body responds later. When your alarm response and reptilian brain is activated, you are primed to respond as if you are dealing with physical danger, even if there is no actual danger. This part of the brain reacts to every worry as if there is a tiger jumping out at you and you need to fight for your life. This is why stress and anxiety make us feel so terrible, like something really bad is going to happen.

For example, if you are worried about speaking in public, you won’t be physically harmed from doing that, but it sure feels like you will from how your body responds! This is because the reptilian part of the brain does not differentiate between what is actually going to hurt you and something that is merely uncomfortable. In fact, the main job of the reptile brain is survival; it is in charge of everything that keeps you alive. This response is often called fight, flight, or freeze. When turned on, this part of your brain signals your body to be ready for danger also, but more about what happens in your body later.

FIGHT

FLIGHT

FREEZE

This part of the brain also works without you actually being aware that it is working and it works rapidly, even taking over from other parts of the brain such as logic and thinking. Think of a time when you jumped out the way of something or reacted before you knew what happened. This is a good thing because you stay away from something dangerous (like a hot stove or an approaching vehicle). So, we don’t want to get rid of the alarm system altogether, we just want to understand and manage it a bit better. Along with sending and receiving information from the body, the reptilian brain also sends and receives information from the next part of the brain we will talk about, the mammalian brain. MAMMALIAN BRAIN (Limbic System) The mammalian brain or limbic system is very complex and has many different parts. Functions such as memory and emotion are also found in mammals hence the term mammalian brain. This brain region is newer to develop in terms of evolution than the reptile brain. For understanding stress and anxiety, we are most interested in two parts of the limbic system, the amygdala and the hippocampus. Overall, the limbic system is responsible for our emotions, which includes the responses in our body when we experience emotions. Think about how different your body feels when you are scared, mad, sad, happy, or anxious. When activated, the limbic system sends feedback to the reptilian brain which then sends feedback to the body. Hippocampus The hippocampus is very important for learning as this is where memories are consolidated and stored so you can retrieve them later. When you are calm and alert, the hippocampus does its job well and stores memories for retrieval later. The hippocampus also connects the emotion fear to the context when a threatening event occurs. Higher levels of cortisol from stress can affect growth and performance as well as memory. When you are anxious or scared, often another part of the limbic system will take over, the amygdala.

Amygdala The amygdala triggers emotional responses such as anxiety or fear. The amygdala is essentially your security guard. Its job is constantly scanning within you as well as the world around you in order to be on the lookout for potential threats. Your amygdala collects information from three main sources: Senses: This information is helpful when actual physical danger is present. For example, you can remove your hand from a hot stove or jump out of the way of an approaching car without thinking. It is an excellent system and keeps you safe. Thinking is much slower so by the time you think about something you would be hurt or worse, it is much better that you just react. If you are someone who has a lot of worry, your amygdala might be labelling information coming through one of your senses (or from your thinking) as a threat when it is not. For example, you might be afraid of something you see like a dog or the audience of a presentation and feel anxious, even though you know most dogs and most audiences will not hurt you. The sensory information can bypass your thinking and be assessed by the amygdala as a threat. An important part of learning to manage stress and anxiety is learning to give the amygdala correct sensory information that you are physically safe, no tigers are jumping out at you right now. The amygdala is often not correct about what it labels as a threat. And once something is labeled as a threat, the rest of the defense system is turned on, even if there is no actual danger around.

TASTE

HEARING

SMELL

TOUCH

VISION

Body: The body refers to our internal systems like the sympathetic nervous system that may include sensations like rate of breathing, muscle tension, heart rate, stomach discomfort and more. These sensations are part of the automatic response to perceptions of threat that the amygdala is in charge of. These body sensations become part of the feedback loop that contribute to our internal sense of safety, which is called neuroception. Our brain is constantly scanning for this information and how we interpret this contributes to escalation of stress or anxiety or down regulation. For example, when we sense our heart pounding, does that contribute to feeling unsafe and out of control or do you experience this as excitement. This will likely change depending on the context also. Body sensations can also be generated by implicit memories (see chapter 9 for more about implicit memories) which explains how past experiences which my show up in the present moment as body sensations and contribute to our current experience of stress or anxiety. For many people, the whole body â&#x20AC;&#x201C; brain feedback loop is typically occurring beneath our awareness and highlights the importance of developing our awareness so we can improve how we manage these sensations. Thinking: The limbic system and amygdala also get information from the human brain, the final part of the brain that we will talk about. We will talk more about thinking later on, just know for now that what you are thinking can have an immediate impact on the whether your alarm system is turned on or turned up. So if you are thinking really negative thoughts, this can be perceived as a threat and turn on or turn up your defense system, even if there is no physical danger. It is very important to remember that your amygdala is scanning for not just actual threats, things that will

actually cause you physical harm, it also processes perceived threats (e.g. negative thoughts). Once a threat is identified, real or perceived, this information activates the rest of your survival or alarm system regardless of how real (or physically threatening) the threat is. Thus, you can have an alarm response or anxiety whether delivering a public presentation or facing down an attack from a tiger. Learning to manage anxiety will involve working with this alarm response so it is not ready to fight tigers that do not actually exist. Human Brain (Cortex) The cortex is sometimes called the human brain, the thinking brain or the professor brain, as it is the ‘smart part’ and the newest part to develop in terms of evolution. We share this part of the brain with other humans and it is the last part to develop. It really only starts to develop and connect to other brain systems around age 5 to 7, major changes happen during adolescence, and development continues well into the twenties. The cortex is also a complex system than processes a lot of information and includes what we call executive functions. These allow you to plan and set goals and most importantly for us, begin to influence and ‘train’ the amygdala and the whole alarm system in your brain and body to be a bit less reactive. We will learn later how thinking will be an important element of this process.

BRAIN BASICS: TRIUNE A N D HIERARCHICAL BRAIN REPTILIAN

MAMMALIAN

• Attends to survival and safety, automatic functions • Regulates heartrate, breathing, digestion • Ancient system • Develops first

• Attends to emotions, memory consolidation, motivation and reward • Content when needs met and frustrated when not • Develops second

HUMAN/PRIMATE

• Attends to executive functioning, connection and attachment • Regulates attention, emotions, complex thought, language, empathy, etc... • Develops last, into mid 20’s • Most recent

HUMAN AND PRIMATE (Cortex)

MAMMALIAN (Subcortical Region, Limbic)

REPTILIAN (Brainstem and Cerebellum)

There is a lot to learn about the brain so let’s review some of the information here:

HUMAN - Main Job: Thinking MAMMAL - Main Job: Security Guard Emotion and Memory REPTILE - Main Job: Survival (Flight, Fight, Freeze)

Something else you should know about your brain is that we feel good when all three parts of the brain are connected and communicating -- in other words, integrated. When we are worried, the bottom two parts of the brain (reptile and mammal) are too busy or excited and causes a break in the connection with the top part of the brain (human). Another way to think about this is that the mammal and reptile brain can be called the downstairs brain and the thinking brain is the upstairs brain (this way of describing the brain is from the book The Whole Brain Child by Daniel Siegel and Tina Payne Bryson, 2012). When you are calm, it is like there are stairs between the upstairs and downstairs brain so these two parts are connected and can communicate. When you are worried, your downstairs brain takes over and focuses on fighting tigers and saving you from danger. When this happens, there is no connection to the upstairs brain. This is why when you are worried, you feel like you do not have control and can’t think very well. When you are worried, the downstairs brain is in charge and its whole job is to focus on survival, like fighting tigers even when they are not there. To shrink the worry, we will learn how to get the upstairs brain back in charge, to connect the upstairs and downstairs brain again. We will use your very own toolkit to do this. CALM Upstairs and downstairs brain are connected

WORRY Upstairs and downstairs brain are NOT connected

Upstairs Brain (thinking)

Downstairs Brain (emotion, worry)

Another great way to understand what happens in your brain when you are worried is to use your hand as a model for your brain.

HAND MODEL OF THE BRAIN

Human Brain (thinking) Human Brain (thinking)

Mammal Brain (Amygdala)

Reptile Brain (Survival)

CALM Parts of the brain are connected, the thinking brain is in charge.

Reptile Brain (Survival)

WORRY Parts of the brain are NOT connected, you are not able to reach your thinking brain easily. The reptile brain is in charge.

Adapted from Dr. Daniel Siegelâ&#x20AC;&#x2122;s Hand Model of the Brain found in Mindsight: The New Science of Personal Transformation (Bantam Books, 2010)

Chapter 2: Your Foundation “I was always looking outside myself for strength and confidence, but it comes from within. It is there all the time.” — Anna Freud

I am excited to teach you how to manage and shrink your anxiety. I know how hard it is to have to deal with worry and how much it can cause distress and interfere with your life. Facing your worry takes courage and building your own 3A Toolkit to manage it takes a lot of energy. Like any strong and stable building, you really need a solid foundation to be able to do this. In this chapter, we will go over some important pieces that will form your foundation that will keep you steady as you face your anxiety and learn a new way of managing it. Think of your foundation as your overall mental health and wellbeing. Mental health and wellbeing is something we all have in varying amounts all the time, in the same way we have physical health to varying degrees. Mental health and wellbeing can fluctuate over time and is separate from dealing with the anxiety. If you have a strong foundation, or flourishing mental health and wellbeing, you are better able to manage your anxiety. These components of your foundation may not directly address your anxiety, but they are related. In other words, the stronger your mental health foundation is, the better equipped you will be to address your anxiety. Supportive People I really want you to have people to help you and support you as you continue to work on managing your worry. When you are struggling with worry, I encourage you to ask for help from a supportive adult in your life or a helping professional such as a counsellor or psychologist. Think about the important people in your life, family members and friends, who are there to help you. Worry can be really isolating, sometimes leaving you feeling like you are on your own. It really helps to have support, to know that there are people in your corner. Perhaps even invite the important people in your life to help you work through this workbook and join you in reading this workbook and working on some of the strategies with you. Consider who are the supportive people in your life. Perhaps write their names in the space below, consider what you appreciate about them, and how you want them to support you. For example, you may want to just tell them about this workbook that you’re reading, you may want to spend more time with them, or you may tell them about some of your goals regarding practicing some of the strategies in the workbook to help you be accountable. Who you look to for support and how you want them to support you is your choice, just know that these connections with the important people in our lives are really important.

Supportive People

What Do You Appreciate About Them?

How Would You Like them to Support You?

Character Strengths A strength is more than something you’re good at, it is a quality about you that you consistently demonstrate and shapes what you do well and how you interact with the world. It is a bit like a ‘truth’ for you, kind of like an anchor. Below are the most commonly named character strengths from research in this area (see www.viacharacter.org for more information). You can choose other strengths if you don’t think these are the best fit for you, but these 24 character strengths give you a good place to start.

wisdom Creativity Curiosity Judgment Love of Learning Perspective

courage Bravery Perseverance Honesty Zest

humanity

transcendence

justice

moderation

Love Kindness SocialIntelligence

Appreciation of Beauty Gratitude Hope Humour Spirituality

Teamwork Fairness Leadership

Forgiveness Humility Prudence Self-Regulation

Choose at least five character strengths that you think apply to you to start with, and consider how each of them helps you. Be as specific as you can. For example, the strength of curiosity keeps you looking for new learning and encourages you to keep an open mind to new experiences. This quality might have helped you asked questions at work even though you were uncomfortable doing this. Curiosity is a very helpful strength for learning about the 3A Toolkit for managing anxiety!

Strength

How this strength helps youâ&#x20AC;Ś.

1. 2. 3. 4. 5. As we continue to learn about the 3A Toolkit and get better at shrinking worry, remember that these strengths are always here to help you!

Positive Emotion Increasing how much positive emotion you experience is beneficial for flourishing, wellbeing, and healthy coping. It can also benefit physical health. Awareness of the benefits of growing the positive aspects of our emotional landscape has really grown in recent years and often falls within the positive psychology research arena. Positive emotion is also thought to help us to recover from challenges easier and be able to face adversity. Paying attention to negative emotion also provides us with important information. Negative emotion can alert us that something is wrong and are essential for our survival. This whole workbook addresses anxiety, which is considered by most people to be a negative emotion and is certainly relevant for survival. The point of attending to and growing positive emotion is not to ignore the negative, rather to grow the positive. We can often miss positive emotion if we are too busy paying attention to the negative. It takes considerable effort to notice the positive. It is often suggested that we benefit when we experience about three times as many positive emotions to negative. In Chapter 9: Strategies to Manage Memory & Emotion, we will further explore how to grow positive emotion. For now, consider how much positive emotion you experience relative to negative emotion and recognize what contributes to feeling more positive for you. Below are some examples of positive and negative emotion.

Positive Emotion

Negative Emotion

Joy

Anger

Gratitude

Annoyance

Serenity

Sadness

Curiosity

Guilt

Interest

Fear and anxiety

Hope

Discouragement

Awe

Despair

Amusement

Apathy

Inspiration

Shame

Love

Disappointment

Satisfaction

Frustration

Relief

Hopelessness

Altruism

Grief

Contentment

Bored

Enjoyment

Insecure

Optimism

Shattered

Happy

Unhappy

Most importantly, positive emotions open our minds, broaden and expand our awareness, and grow our resources. Mindful Awareness Another component of your mental health foundation is Mindfulness, the process of bringing your attention and awareness to your present moment experience without judgment (Williams et al., 2007). Examples of mindfulness practice include breath awareness and body scan. One of the ways mindfulness works is by creating space between a person and their thoughts and feelings. This can make the difference between being ‘hooked’ by a negative thought or feeling and being swept away by it, versus being able to tolerate it. Mindful awareness will be important for all three phases of the 3A Toolkit. Mindfulness is also linked to improved neural integration, benefits to physical and mental health, and reductions in anxiety, among other positive results. There are many Apps available that support a regular mindfulness practice. If you are not ready for long mindfulness practices, even a few minutes can be beneficial. A great place to start is the three minute breathing space (Williams et al., 2007) (https://www.mindful.org/the-three-minute-breathing-space-practice/ ). Like other strategies and practices, mindfulness takes practice. I suggest practicing daily if possible.

Values and Beliefs While character strengths address an important quality about you as a person, values and beliefs are important ideals you hold about the world around you or how you interact with the world. For example, you might value being adventurous and honest and believe that everyone should be treated fairly. Anxiety can lead to changes in the way you act and interact with the world around you. Sometimes this can be challenging as anxiety will get in the way of you doing what you really want to. Consider what is most important to you, what you value and believe. Anxiety will often cross paths with key values and beliefs and it will start to feel like anxiety is making the choices for you. For example, if you value trying new things and being adventurous, anxiety may get in the way of living according to that value as the negative sensations and experience of anxiety override the desire to try new things. Consider what is important to you, what do you value and believe?

How does your anxiety get in the way of living your life according to these values?

Now that you can see how much better it will be when worry or anxiety is no longer making choices for you, and you are able to be more consistent with what you value and believe, letâ&#x20AC;&#x2122;s have a look at the plan for learning to manage and shrink your worry. As we move through the rest of the workbook and you start to build your 3A Toolkit, remember all the pieces of your foundation that will help you stay steady and strong as you do this challenging work.

Supportive People

Values and Beliefs

Mindful Awareness

FOUNDATION

Character Strengths

Positive Emotion

Chapter 3: The 3A Toolkit Plan for Managing Anxiety “Our anxiety does not come from thinking about the future, but from wanting to control it.” — Kahil Gibran When we are feeling good and are happy, the different parts of our brain are connected or integrated. When we are anxious, these brain regions are not communicating well. In times like this, the subcortical brain regions (mammal and reptilian brain) take over and your thinking brain is no longer in charge. Our goal then is to create better connections and better integration between these brain regions as this is what supports wellness. We will do this by working through three stages of anxiety management. These steps form the foundation of the 3A Toolkit.. There are three sections to the 3A Toolkit: 1. Awareness (Collecting Information) 2. Assign a Label (Organizing Information) 3. Action (Responding to the Information) THINKING (TOP DOWN) STRATEGIES

PRIMATE/HUMAN BRAIN (Cortex)

MAMMALIAN BRAIN (Subcortical Region)

Amygdala

Hippocampus

REPTILIAN BRAIN (Brain Stem & Cerebellum)

BODY (BOTTOM UP) STRATEGIES

In Part One: The Essentials, you will be introduced to the 3A Toolkit. The image of an hourglass will help you remember this. Consider Awareness to be like the top part of the hourglass where you collect information about what you are thinking and what is going on in your body. The narrow middle part of the hourglass represents Assign a Label where you will provide a feeling label to describe your experience. The bottom part of the hourglass is the Action section where you respond to the thinking and body activation you noticed in the Awareness section. As you can see, working through both Awareness and Action steps in the Toolkit include a combination of ‘top down’ (thinking) strategies, ‘bottom up’ (body based) strategies. Part Two: The Extras will then offer some additional information regarding how relationships, emotion, and memory can also impact your experience of anxiety. That is, Part Two of the manual will offer additional relationship strategies and emotion and memory strategies for managing your anxiety. The 3A Toolkit Plan for Managing Anxiety: PART ONE: THE ESSENTIALS

AWARENESS 1. Thinking 2. Body Activation PART TWO: THE EXTRAS

ASSIGN A LABEL

3. Emotion and Memory 4. Relationship Strategies

ACTION 1. Thinking 2. Body Activation

We will be working towards building you your very own 3A Toolkit so you can manage your anxiety. Let’s get started by learning more about the three sections of the 3A Toolkit: Awareness, Assign a label, and Action.

3A TOOLKIT: AWARENESS SECTION To solve a problem, you have to collect information about it. This is also true for learning to manage your anxiety. Collecting information is the main purpose of the Awareness section. here are two main categories in which we need to collect information and be aware of: 1. Body Activation 2. Thinking Awareness 1: Body Activation Going back to the example at the beginning of this workbook, worry includes changes in your body as well as your thinking. When you are worried or you are responding to stress, there is a system in your body called the nervous system that gets you ready to defend yourself. Remember from the section on the brain, this happens automatically and gets you ready to respond to physical danger such as fighting off tigers even when no actual physical danger is present. This helps to understand why worry can feel so terrible and overwhelming -- worry gets your attention and overrides your thinking. This is very helpful if you are facing actual physical danger. Consider that you come face to face with a bunch of tigers, you really need to pay attention to them as they could eat you, and the unpleasant body sensations that accompany the fear are useful for getting you to pay attention to this threat and to respond in a way that saves your life. However, as with most experiences of anxiety, there is no physical danger present. When you are worried or anxious, your nervous system is activated and changes in your body follow. Some of the body changes include a fast heart rate, fast breathing, sweating, and stomach discomfort. It is important to know what changes you notice in your body when you are worried so we can help find strategies to help calm down your body. We go through this in much more detail in Chapter 4: Strategies for Body Regulation including the importance of assessing your level of activation and then matching the appropriate strategy with this level. As an important note, we wonâ&#x20AC;&#x2122;t cover much of the freeze response in this workbook. The freeze response represents a higher level of a dysregulation than fight or fight. Freezing is a common response to traumatic experiences and is associated with the parasympathetic nervous system. If you are someone who has a freeze response, it may take longer for you to return to a regulated state than with fight or flight. Freeze responses can be associated with dissociation and if this is true for you, I suggest seeking some guidance from a qualified helping professional to guide you through managing this response. Here are some examples of what you might notice when you are worried (e.g., fight or flight response):

SYMPATHETIC NERVOUS SYSTEM ACTIVATION

OBSERVABLE EFFECTS

HIDDEN EFFECTS Pupils dilate

Dry mouth

Brain signals body to be ready to respond to threat

Tense shoulder and neck muscles Increase in adrenaline for fight or flight

Rapid heart rate

Increase in cortisol Rapid and shallow breathing to divert oxygen to muscles Liver releases glucose to fuel muscles

Increase in blood pressure

Sweating

Consider what changes you notice in your body when you are worried. Write on the body shape below any places that you notice the body changes from worry in your own body. For some of you, it might be a tight feeling in your stomach, for others it might be fast breathing, other people might notice tight muscles or sweating. Make a note below of the body clues for you that indicate that worry is getting too big and will need some shrinking:

The important questions to ask yourself about body activation are: What do I notice about my body? What is my level of activation?

Awareness 2: Thinking What we think has an impact on how we feel, and it certainly impacts how worried we feel. With worry, thinking is filtered by the downstairs brain for anything that might be a threat. More positive or helpful thinking will let the amygdala and downstairs brain know that all is well, nothing to worry about. Negative or not helpful thinking can be tagged by the downstairs brain as a threat. This is followed by turning on the defense response and alerting the reptile brain to defend against danger. Our minds and brains are very busy and we are constantly thinking all day long. Some of these thoughts are helpful and others much less so. We tend to notice the less helpful thoughts more than the helpful ones. This is probably for survival reasons linked to our evolutionary past. For example, if we did not pay attention to a negative thought such as “what is that scary sound over there,” this might impact our survival. Thoughts that are bad or negative tend to stick to us more easily than the positive ones. Negative thoughts are a big component of anxiety so it is important to work on helpful and healthy thinking. Examples of negative or not helpful thoughts include “I can’t do this”, “I can’t handle this”, and “this is terrible”. These kind of thoughts are feeding the worry and making it bigger. There is a very important question to ask when you’re trying to figure out if something you’re thinking is making your worry bigger. Ask yourself: Is this thought helpful? If the answer is yes, then by all means keep going with no changes. But my guess is, because you are taking the time to read this workbook, your answer to the above question is most likely not yes! If the answer is no, then we will need to work on more helpful thinking in order to shrink the worry. Noticing which thoughts are not helpful and are possibly fueling your worry is very important. The goal is not to stop these thoughts though, only to be aware of them. When you try and stop thoughts that are not helpful, you end up paying more attention to them and making them seem stronger. For example, try to not think about cupcakes for the next few minutes. What happens? You will notice that as soon as you try to not think about cupcakes, you think about them more. This is the same with worried or not helpful thinking -- if you try to not think worried thoughts, it does not work very well. Instead, use your mindful awareness to just notice the thought and the fact that it is not helpful. We will talk more about what to do about the unhelpful thoughts in Chapter 5: Strategies for Helpful Thinking. Reflective questions to grow awareness: You will have noticed that for each category in the awareness section, there have been reflective questions in red that will help you to be curious about your experience and to grow your awareness of what is happening in your thoughts or your body, which will help your subsequent ability to choose the most helpful action strategy. Here is a summary of those questions: Awareness Category

Important Reflective Questions

1. Body Activation

What do I notice about my body? What is my level of activation?

2. Thinking

Is the thought helpful?

Now that you know what to look for in terms of thinking that is not helpful, and signs of body activation, you have completed the Awareness section. You have collected important information about yourself and your worry. Now we will move on to Assign a Label section.

3A TOOLKIT: ASSIGN A LABEL SECTION You have now collected information about what you are thinking and what you notice about your body when you are worried. Now it is time to start shrinking the worry. The first step is to organize the thinking and body information you noticed by choosing a feeling label. In other words, Name It to Tame It (From the Whole Brain Child, by Daniel Siegel & Tina Payne-Bryson, 2012). For example, when you notice the negative thinking, rapid breathing, and sweaty palms that are part of your worry, simply say “I feel anxious” or “that is my anxiety acting up” or “that is just my anxiety”. This is an example of naming or labeling what you are feeling. When you do this, you turn the volume down on your amygdala just a little bit. This simple strategy is very effective in starting you on your way to being able to manage your stress and anxiety and a very important step before moving to the action strategies. You don’t have to wait until you are feeling worried to Name It to Tame It. Practice naming all sorts of feelings to get lots of practice. What label would you give to these feeling faces? There is no right or wrong answer, what matters is that you use the feeling label that makes sense to you. Be as specific as possible. I feel _______________________________________________________________________

I feel _______________________________________________________________________

It is also really helpful to get to know your worry a bit better. Remember that we are not trying to totally get rid of your worry, we need it to survive. We just need to retrain your worry, manage it better, and shrink how big it gets. By the end of this workbook, you are going to shift how you relate to anxiety so that you have an improved relationship with it. Let’s get started right away on learning how to shrink your worry to a more tolerable level. I will explain how we will do this in the next section that tells you about the action phase of the toolkit.

3A TOOLKIT: ACTION SECTION The final section of the 3A Toolkit is the Action section. In the Awareness section you learned about what is happening in your brain and body when you experience stress or anxiety and you have also learned how to collect information about what you are thinking and how your body responds to stress and anxiety. In the Assign a Label section, you learned to organize the information from the Awareness section by giving this information a label. Now you are ready to match regulation strategies that you will learn in the Action section with what you found in the Action and Awareness sections. In the Action section, you will have two categories of strategies that match the two categories from the Awareness section, to help you manage and shrink your anxiety. The strategies in the Action section will help foster the integrated brain and help you recover from ‘flipping your lid’. The strategy categories are: 1. Body Calming 2. Helpful Thinking We go through the Body Calming and Helpful Thinking strategy categories in more detail in the next two chapters. For now, here is the overall 3A Toolkit plan for shrinking anxiety: Awareness • Body Activation • Thinking

Assign a Label

Action • Body Calming • Helpful Thinking

When you are finished the workbook, you will have your very own 3A Toolkit so you are able to manage your anxiety. Below, there is a blank 3A Toolkit that we will fill in as we continue:

TOP-DOWN AWARENESS

(Collecting information)

ASSIGN A LABEL

(Organizing information)

ACTION

(Responding to the Information)

Practice One more thing before we start to fill up your strategy categories for body calming and helpful thinkingâ&#x20AC;&#x201D;you will need to practice all of the strategies before you can use them easily! This is really important, to learn anything new, you need a lot of practice. Think about when you learn something new in a class, at work, or a new skill in whatever sport you play. You are not able to do the new thing well the first time, but after lots of practice, you will do it better. This is the same with strategies for shrinking worry. You will need to practice them before they work well. In a way, you have been practicing being worried without meaning too, and you are really good at being worried! So, you will also need to practice managing your anxiety, which will take some time.

Summary So far in this workbook we have gone over the 3A Toolkit approach for managing anxiety including the Awareness, Assign a Label and Action sections. In the next chapters, you will learn strategies to develop helpful thinking and to calm the body. We will address body calming strategies first and then proceed to the helpful thinking strategies. But, if you want to learn about your thinking before learning how to calm your body, you can read the thinking chapter first. In whatever order you learn about the strategies, just know that you will need to be able to use strategies from the different categories to effectively manage your anxiety. In general, you will always need a thinking and a body calming strategy. For some of you, you will also benefit from a relationship or an emotion and memory strategy which you will learn about in Part Two: The Extras.

Chapter 4: Strategies for Body Regulation “Life is ten percent what you experience and ninety percent how you respond to it.” — Dorothy M. Neddermeyer Being aware of how your body responds to stress and anxiety, sometimes referred to as your ‘bottom up’ response, is very important. It is also important to recognize that different types of strategies work for different levels of physiological activation. For example, if you are very activated, perhaps even approaching panic, breathing exercises do not always work and may even heighten your activation level unless you have had a lot of practice with breathing exercises. Therefore, a first step is to notice your overall level of activation. In general, if you are at a medium to high level of activation, try a strategy that involves more movement. Imagine that when you have a high level of physiological or body activation, it is like your body is full of tiger fighting energy. You can’t go from fighting tigers, which is the state your body is in when you are anxious, to calm instantly, it takes time to return to a regulated or calm state and to a feeling of being safe. Level of Activation While the scale you use is not that important, what does matter is the concept that we have different levels of activation which correspond with different physiological events and are managed by different strategies. For example, if you choose a 10 point scale where 0 represents being asleep and 10 represents a panic attack, the 0 to 5 range corresponds with low to medium levels of activation and 5 to 10 corresponds with high activation such as panic. Whatever scale you use, the important part is to differentiate between low to medium levels of activation and high levels of activation because different bottom-up strategies will be effective depending on the level of activation. The purpose of the bottom up or body regulation strategies are to manage your physiological response. The goal is to get to a state of calm, but this can be a lofty goal for many people who struggle with anxiety. Many people rarely feel calm. Thus, while calm is the goal to work towards over time, the immediate focus is on down regulating the activation level in your body. You can think of this as if you’re ‘turning down the volume’ on your body’s response. With practice, you will get better and better at this and over time be able to achieve a feeling of calm. As a general guideline, breathing and muscle relaxation will be effective in the low to medium range (0 to 5 on the sample scale), while movement will be effective in the high range. I have had many people tell me that breathing doesn’t work for them and makes their anxiety worse. When we investigate more fully, we realize that they are using breathing during a period of high activation which often increases their level of activation. There are many different breathing and body regulation activities. I will outline only a few of them here. I encourage you to add your own favourites to the list. Below, I will share some ideas of strategies that will help you to down regulate your body’s response to stress and anxiety. I will provide some for low to middle levels of activation and others for middle to high levels of activation. Most important however, is to find body regulation strategies

that work for you. Also recognize that you must practice these, starting off by practicing them when you are already calm, so that you can effectively use them when you are experiencing stress and anxiety. Typically, you will need to practice for several weeks before you are able to use the strategies effectively to settle down your bodyâ&#x20AC;&#x2122;s response to stress and anxiety. Also, keep in mind that everyone is different and you need to find the strategy that works for you. The list provided here is by no means exhaustive, and you will likely want to consider adding your own. Keep practicing until you find what works best in your 3A Toolkit! Before we get to the strategies, consider what kind of stressors or triggers correspond with different levels of activation, where 10 is very high (e.g., panic) and 0 is very low (e.g., asleep). Write down a few of the situations and events that tend to lead to lots of worry for you and some of the situations and events that lead to a little bit of worry for you. Imagine that the number 0 to 10 represents how full of worry your body is with between 0 and 5 being a low to middle level of worry and 5 to 10 being a high level of worry.

Level of Activation 10

Stressors and triggers

It is important to notice how activated or full of worry your body is so you can match the right strategy to the level of activation. Below are some examples of strategies that match to the level of activation you are experiencing. They are explained in more detail next.

Body Regulation Strategies 10

Medium to High Level of Activation Walking, Running, Sport Activity of Your Choice Bilaterial movements that are slow, rhythmic and intentional (e.g. butterfly hug, finger pushups) Shaking

Low to Medium Level of Activation 5

Orienting Breathing practice with a focus on a long exhale (e.g. figure 8 breathing) Yoga or other movement that is slow and gentle Progressive muscle relaxation

Mindfulness

Body Calming Strategies for Low to Medium Level of Activation Breathing There are many different breathing exercises. For managing high activation such as anxiety, the general principle is to focus on a longer exhale and on breathing from the diaphragm rather than the chest. It can be helpful to go through even breathing (when the exhale and inhale are of similar lengths), breathing with a longer exhale, and breathing with a longer inhale to increase your awareness of your breathing patterns. A longer inhale is usually more activating and the opposite of what you want if you are working on managing stress and anxiety. The longer inhale can be useful when you are trying to be more energetic but this is not what we are working on in this workbook.

Figure 8 breathing Draw a figure 8 on the back of your hand. If you do not want pen on your hand, you can trace the shape with your finger. Trace the figure 8 with your finger, exhale as you trace the curve of the 8 and pause and inhale as you reach the center where the lines intersect. I find this breathing exercise helpful as it makes it easy to focus on the exhale, it brings your attention to the present moment, and the touch of your finger on your skin is soothing. I usually practice this for at least one minute a day. It is important to practice these new skills when you are not anxious so that you can use them effectively when you are.

Figure 8 breathing Progressive Muscle Relaxation Progressive muscle relaxation is an established practice and many different scripts and protocols exist for this practice. I will leave it to you to find your favourite -- there are many options available with a quick search online. The key principle of this practice is to move through different regions of the body and tense one region at a time and bring your full awareness to the experience, then relax the same body region for about twice as long as you were tense for. In this way, you develop awareness of where you hold tension in your body and become capable of relaxing when you set your intention and attention to do so. An example of body regions you may choose to focus on when tensing and then releasing your muscles are: right arm, left arm, face and head, neck and shoulders, mid-section, right leg, left leg. Once tensing and releasing your muscles in those regions, finish the practice with a body scan to see if any tension remains.

Orienting Orienting is another widely used practice. Orienting is a way of bringing attention to the present moment and providing the brain with information that you are safe in this moment. There are different orienting practices and I suggest finding one that is a good fit for you. A very simple practice is to simply name objects that you see in the space around you. This gives the amygdala, the security guard, information that there is in fact no physical threat present so it will settle down a bit. A longer orienting practice that I find more effective is 5, 4, 3, 2, 1. In this practice, the client names 5 things they see, hear, and feel. This is followed by 4 then 3 then 2 then 1 thing they see, hear, and feel. This practice engages multiple senses to provide the amygdala with accurate information about safety, thus providing down regulation of the amygdala and nervous system.

Mindfulness Along with being important for your foundation of strong mental health and wellbeing, mindfulness (present moment awareness without judgment) can also be helpful for reducing body activation when you are worried. Just be aware that mindfulness can be challenging for many people with anxiety or a history of traumatic experiences. If you have trouble with mindfulness practice, know that it really is worth learning how to do, but perhaps seek assistance from a trained helping professional and know that it can be a difficult for some people.

Body Calming Strategies for High Levels of Activation As previously mentioned, breathing is not always effective for high levels of activation. For high levels of activation, regulation strategies involving movement are often more effective. There are many different ways you can incorporate movement strategies and I suggest using activities that you are interested in such as a sport you enjoy, yoga, and dance. Just going for a walk can also be helpful. What is important is to come up with movement that you like and will actually use. Other movement approaches for when you are not able to leave the room include the following (not an exhaustive list):

Finger Pushups Press the fingers tips of both hands together, then slowly and intentionally lift each pair of fingers away from each other and then press them back together. Continue this way with each pair of fingers for as long as needed.

Bilateral Foot Movements This exercise works well when you are seated and not able to get up and walk. Slowly and intentionally lift the toes and ball of one foot keeping the heel on the ground, and then follow the same movement with the other foot and continue as needed. Keep the movement slow and measured as quick movements may increase the level of activation.

Butterfly or Bear hug Place each hand on the opposite arm in a gentle self-embrace using the amount of pressure that feels soothing. Then alternate squeezing one side and then then other. Some people like a gentle embrace (butterfly hug) and others prefer much firmer contact (bear hug).

Shaking Engage in vigorous” shaking of your whole body for about a minute. You will notice partway through this practice that you really want to stop. This lets you know your ‘brakes’ are starting to work. Once the time is up, allow yourself to rest, feeling your relaxed muscles. This practice works really well for people who go to a high activation very quickly. I suggest finding somewhere private to do this as you do look a bit silly. Many people report very quick results with shaking though, they are able to regulate quite quickly so it really is worth trying.

Practice, Practice, Practice…. As I mentioned before, whichever strategy you think will work for you, you will need to practice it. Perhaps choose a strategy from the low to middle level of activation section and another one for the higher levels of activation and practice those for a week at least and see how they work for you. You usually need about three weeks to start to be really good at something new. If you find a strategy doesn’t work for you or you don’t like it, try another one. There will be something that works for you, but you may need to try a few things before you find the right match. And 36

remember, match the strategy with how activated your body is. Otherwise, even the right strategy won’t work if you use it for the wrong level of activation. Breathing is a good example of this. Breathing is wonderful for calming down the body. But it does not always work well for higher levels of activation. In fact, some people find it even makes them feel worse. This doesn’t mean that breathing doesn’t work, it just means you need to use it at the right time. Enjoy your practice and know that you are getting better at shrinking your worry every time you practice! Now that you have learned a few strategies to calm your body down when you feel anxious, what will you try when you notice a low to middle level of activation? How will you incorporate this practice into your day?

What about when you notice high levels of activation, what movement strategies will you try to calm down your body? How will you practice this?

Chapter 5: Strategies for Helpful Thinking “You may not control all the events that happen to you, but you can decide not to be reduced by them.” — Maya Angelou From the Awareness section of the 3A Toolkit, we have already noticed thinking that is not helpful and is probably fueling the worry. In this chapter, we will work on what to do after we have noticed thinking that is not helpful. Basically, we need to work on creating thinking that is helpful! There are two categories of helpful thinking that you will learn about: 1. Messages of safety 2. Specific helpful thinking Before we explore these two categories of helpful thinking in more detail, I want to remind you that it does not work very well to try and stop the “unhelpful” thoughts, such as “I’m never going to be able to do this”. Instead, this brings your attention to them even more and tends to grow them even bigger. Remember when I said to you, “I don’t want you to think about cupcakes”, what did you think about? That’s right…. cupcakes!! Simply notice the “not helpful” thinking, label it as “not helpful”, and shift your focus and energy on generating helpful thinking such as Messages of safety and Specific helpful thinking. Messages of Safety From the Awareness chapter, we know that when we are worried and ‘flip our lid’, our brain is basically fighting tigers and ‘thinks’ that we are in terrible physical danger, even when we are not. So, an important part of learning how to have helpful thinking that will shrink your worry is to give your brain the message that you are physically safe. A bit like you are talking directly to your downstairs brain. You have started to do this in the body calming section, because these strategies help you to feel safe in your body. Orienting is a really useful strategy for giving your brain the information that you are safe (check Chapter 3: Strategies for Body Calming for a description). With orienting, you are using your senses to give your brain the correct information that you are safe and not being attacked by tigers. You can add another layer of calm and shrink the worry a bit more by giving yourself and your downstairs brain messages that you are safe. You can use any message that reminds you that you are safe. Here are some examples: “I am safe” “There are no tigers here” “It is just my worry that is making me feel like this, I am safe” “I can handle this” “This feeling will pass soon”

What are some other messages of safety that will help shrink your worry?

Choose a couple of messages of safety that will work best for you and be ready to use these to shrink your worry next time it is too big. You can use the messages of safety anytime you are worried, although it is easier to use any thinking strategy when your activation level is not quite as high. The higher your level of activation and worry, the more you will have ‘flipped your lid’ and the harder it will be to think at all. So try to use the messages of safety as soon as you notice your anxiety. Sometimes, you will have some unhelpful thoughts that you want to deal with more directly. For these thoughts, we will work on how to create specific helpful thinking. Specific Helpful Thinking Generating helpful thinking takes practice. Helpful thoughts are not just a case of using the opposite thought. Rather, the thought needs to be believable. Sometimes the helpful thoughts are not even related to the not helpful thought. Helpful thoughts typically have these characteristics: • Present moment focused • Focus on how capable you are • Focus on what you can influence For example, if your not helpful thought is “I can’t do this” when you are experiencing anxiety about a performance, this is clearly unhelpful. To generate a helpful thought, thinking the opposite thought, such as “I will be amazing,” will not be believable as there is too much of a gap between the current thought and the more helpful one. Instead, try something like “I can get started” (present focus), “I have the training and practice to do this” (foster capability), and “I have practiced a lot and I will do the best I can” (what you can influence).

More Thinking About Thinking We have talked about how thinking, especially thinking that is negative or not very helpful, can be assessed as a threat and lead to heightened activation and an increase in anxiety. We also talked about countering this with general messages of safety directed towards the reptile brain to assure that brain region that we are not in physical danger. It is also important to know that negative or not helpful thinking, which is common with anxiety, tends to be more ‘heavy’ than helpful thinking. We see the not helpful thinking as being more true and relevant than other thinking. Instead of trying to stop the thinking that is not helpful, the recommendation is to notice it, label it as not helpful, and focus on generating more helpful thinking. The building blocks of helpful thinking include a focus on the present moment because anxiety is most often about the future or situations that are hypothetical, on things that highlight your capability, and on things you can influence. While you have heard this information on thinking already in this workbook, we now want a chance to think about this a bit more. It takes practice to be able to notice thinking that is not helpful and shift to more helpful thinking. For many people with anxiety, they have been practicing thinking that is not very helpful for a long time, even if this was not done on purpose. It takes more effort to shift from a negative state to a positive one, so it also takes considerable effort to shift from negative or not helpful thinking to helpful thinking. It really is worth the effort though! You may have noticed that thinking can be described in several ways including negative, distorted, irrational, and not helpful. I have chosen text to use the descriptions helpful versus not helpful as these are simple labels and they also keep you from expending energy on whether the thought is true or not. This really is not a good use of your time and energy when managing anxiety. For example, if the not helpful thought is “I’m an idiot”, you may believe this to be true depending on the context and circumstances, how other people have treated you, and how much anxiety and stress you are dealing with that day. Arguing with yourself about whether this is true will keep you stuck in the cycle of not helpful thinking. Instead, label this as not helpful which is hard to argue with. Then move more quickly to a focus on what is more helpful.

Here are a few examples of styles of not helpful thinking that you can look for: Not helpful thinking style:

Description of not helpful thinking style:

Jumping to conclusions

Judging a situation based on assumptions instead of facts.

Mental filtering

Paying attention to only the negative details and ignoring

Magnifying

Magnifying or exaggerating negative aspects of a situation.

Minimizing

Minimizing or discounting positive aspects in a situation.

Personalizing

Assuming the blame for problems even when you are not responsible.

Externalizing

Blaming others for problems when you are responsible.

Overgeneralizing

Assuming that one bad thing will lead to repeated bad things.

Emotional reasoning

Assuming your negative emotions are the only reality or confusing feelings with facts.

Catastrophizing

Believing something is far worse than it actually is.

the positive.

Adapted from David Burns (1980) Feeling Good: The New Mood Therapy

Let’s try this out with your thoughts that are not helpful. I will provide a few examples of not helpful thinking on the left. On the right, I will provide an example of thinking that is more helpful. There are blank spaces below the examples so you can practice generating helpful thoughts to counter your own not helpful thinking. Continue with this practice by writing out a not helpful thought on the left, cross it out and generate a thought that is more helpful. Remember that the helpful thought may not be the opposite of the unhelpful one, and sometimes it won’t be that closely related, but it will include the building blocks of helpful thinking. The building blocks of helpful thinking are: • a present moment focus (instead of the typical future focus of anxiety) • focus on capability (e.g. what you are capable of doing right now) • focus on what you can influence (instead of what is outside of your control) Once you have some examples of helpful thoughts, you may want to keep these with you so you can remember them when needed.

NOT HELPFUL THOUGHT Not Helpful Thought I’m an idiot I’m idiot ando I can’t this

I will never get better I can’t do this

I will never get better

HELPFUL THOUGHT

Helpful Thought (present moment focus, focus on capability, (present moment focus, focus on capability, focus on on what you can influence) focus what you can influence) I have worked hard on this presentation and will focus on what I know

I have worked hard on this presentation and

I will get through thisI and learn from any miswill focus on what know takes that I make I am working on managing my anxiety better and will practice my helpful thinking as I do I will get through this and learn from any thismistakes presentation that I make

I am working on managing my anxiety better and will practice my helpful thinking as I do this presentation

Remember that even if you are not able to notice the not helpful thinking and generate more helpful thinking while you are feeling stressed or anxious, you can work on this afterwards as you debrief experiences of anxiety. The reflective process of debriefing past experiences of being anxious will be explained in detail in Chapter 6. It really does take a lot of practice to notice not helpful thinking and generate helpful thinking. A good way to practice this is to write down a not helpful thought in the middle of a piece of paper. Then layer on top of this about 5 or 6 helpful thought cards until the not helpful thought is covered up completely. This shows you that you need many more layers of helpful thoughts to balance out a not helpful one.

Not Helpful Thought Very HEAVY

Helpful Thoughts Need 3 to 5 times as many to offset the Unhelpful thoughts

Here are some examples of Not Helpful thoughts that are very common and act as fuel to grow the worry. “I can’t do it” “I am all alone” “I will never figure this out” “Something bad will happen” “Everyone will laugh at me” “I need this to be perfect or….” Practice adding layers and layers of helpful thoughts by writing one of the examples above of a not helpful thought in the middle of a piece of paper. Then use the cards below (print them and cut them up) as examples of helpful thoughts and layer on at least 5 helpful thought cards. Keep going until you feel you have balanced out the thoughts so that the helpful ones are ‘heavier’ or ‘stronger’ than the not helpful one. You will need to figure out for yourself how many helpful thoughts are needed to balance out a not helpful thought. Each not helpful thought will have a different weight that is unique for you. © 2020, MEG KAPIL, ALL RIGHTS RESERVED

HELPFUL THOUGHT CARDS:

I am safe

This feeling will pass soon

There are no tigers here

I am trying

I can handle this

I am doing my best

I can figure this out

I am kind

I can ask somebody to help

I am a good friend

I can remember my helping hand

I am not able to do this YET

That is just my worry, it is not true

I have practiced and prepared

Everyone wants me to do well

I am proud of how hard I have worked

I am learning I can figure it out

My worry is making up stories again

I am enough

I am creative

This is a journey

I am learning

There is no right way

This won’t define me

I love that I am different

I am loved

Blank cards so you can add your own helpful thinking cards:

Example of How to Layer Helpful Thoughts Over Not Helpful Thoughts:

My worry is making up stories again

That is just my worry, it is not true

I am safe

Something bad will happen There are no tigers here

I can handle this

This feeling will pass soon

Keep practicing this process of layering helpful thoughts over unhelpful ones with examples from your own life. You really need to practice this often to be able to notice your not helpful thoughts, to be able to focus on helpful thoughts, and to shrink your worry. The Anxiety Story We have talked about how unhelpful thinking can increase your worry. More than just thoughts, worry will also tell a whole story that can be really convincing. Although much of our thinking is automatic, we also tend to craft a story or narrative that helps make sense of our experience. Consider the example from the beginning of this workbook of a person who is anxious about public speaking. This person has thoughts that are not very helpful including “I’m such an idiot” and “this is going to be a disaster” that fuel the anxiety. This person also will have a story or narrative that is automatic and helps pull together the different pieces of the experience of anxiety, including body sensations, thinking, history, and future fears. This story that the anxiety crafts helps make sense of the experience and can keep you really stuck. For example, consider again the example from the beginning of this workbook about public speaking. The anxiety story may go something like:

“I have always had anxiety about public speaking, nobody has ever been able to help with this and I will likely always suffer from anxiety about public speaking. I will never be able to do public presentations so I will get worse marks in school and won’t be able to get a job where I have to do public speaking. So, I will never make a good living and I won’t be able to have a good relationship or family and I will always be lonely and alone and then I will probably be very sad and my life will be terrible” When you read this, you will notice that this narrative goes very quickly from the present moment sensations and thoughts about anxiety related to public speaking to having a terrible life. The story may seem like an exaggeration. But for many people I have supported with anxiety, this is fairly typical. Looking beyond the individual thoughts that are not helpful to the whole story helps you understand what is keeping you stuck and getting in the way of managing your anxiety. The anxiety story is very compelling and fits with the unpleasant physical sensations of anxiety, so it feels true even though it is not. The anxiety story above predicts the future, is not based in fact, and makes many terrible assumptions full of doom and gloom that are not actually reasonable. But, this story matches so closely with how you feel when you are anxious that it appears credible. For this reason, it can be hard to spot the anxiety story; you may believe this kind of story for no other reason than it matches how you feel and it is familiar to you, this does not mean it is true! Just as we did with the unhelpful thoughts, when you notice an anxiety story, be curious and ask yourself:

Is this story helpful? Once you start to notice the anxiety story, you may also be tempted to reason with it, challenge it with logic. This does not usually work very well because anxiety is generated by brain systems (the limbic system and reptile brain) that are concerned with survival and responding to perceptions of threat. Anxiety is seeking certainty that there is zero threat, and that is never possible. For example, you cannot conclude that you will not make a mistake in your presentation, that a dog will never bite you, and that you will never get in a car accident. For this reason, anxiety will never be satisfied with your logical counterargument because you will never achieve complete certainty regarding safety and can end up getting stuck in what is often called the content trap. The Content Trap The content trap refers to the cycle of questioning and reasoning with an anxiety story that keeps you going in circles and focusing on what worry is telling you instead of the process of worry itself (Wilson & Lyons, 2013). You may do this with yourself or other people may try to reason with your anxiety story. For example, imagine you were speaking with the person in the example about public speaking anxiety. You might say to them, “don’t be silly, you’ll do fine in your presentation”. They will likely not believe you because they do not feel fine in this moment. They may reply with something like “….yeah but I know I will mess up because it happened before”. So, you tell them “you have prepared well and know the material” and they again respond with “yeah but that doesn’t matter, I always mess up”. You can see where this is going, in circles! Instead of becoming part of the anxiety story, it is important to realize that the content of the anxiety story is not really the issue, it is the anxiety itself that is the problem. In the example above, instead of reasoning with the anxiety, use the 3A Toolkit approach to notice, name, and address the anxiety itself.

For example, working through the 3 A’s: Awareness: Body – notice physiological aspects of the anxiety Thinking – notice the anxiety story and other examples of not helpful thinking Assign a Label: • Name the emotion (e.g., anxious) • “that is just my anxiety” Action Body – calm down the body Thinking – focus on more helpful thinking This is far more effective than continuing with the anxiety story and continuing to fuel the worry. Once you are aware of the story that anxiety is telling you, you are able to craft a narrative that is more helpful. For example, with our example of public speaking in mind, this is a more helpful narrative: “I have been dealing with anxiety about public speaking for a long time but I am now ready to learn about ways to manage this and work towards being more comfortable with public speaking. I know this will be hard and I will not always be able to be comfortable with public speaking, but I know I am trying hard and I will learn and improve. I am proud of myself for not giving up and avoiding public speaking altogether, even though some days this seems easier. I think I will be able to try more new things, which I want to be able to do, when I get even better at managing my anxiety” Now consider recent experiences of anxiety for yourself. What was the story that anxiety crafted about your experience?

What is a more helpful story to tell about your experience of anxiety?

Once you are aware of the stories that anxiety tells, you can start to tell a far more helpful narrative about your anxiety and really consider what you want in this more helpful version. Free Write About Your Worries One more strategy that can help address unhelpful thinking and the stories told by anxiety is to free write about your worries (Pennebaker, 2000). To do this, take 10 minutes to write non-stop about all the things that are worrying you. The main rule is that you cannot stop writing. This means that you write ‘stream of consciousness style’ without editing or stopping or even reflecting on what you are writing. Researchers believe this free writing activity allows you to “unload your anxieties”, kind of like you are taking all that worry that is circling around in your head and putting it outside of your mind and onto a piece of paper. By offloading all the anxiety thinking onto paper, you actually free up some working memory (executive functioning) for other tasks. The best part about this strategy is that it works in the moment and it is very easy to use anywhere anyplace! One caution, however, is to try this first when you are not preparing for something important. Most people find they feel much better after this activity but for a few people, they feel more anxious in the short term. Very often, people who try this free writing are surprised by what ends up on the paper, they can end up writing down worries that they were not even aware of. Also, quite often people are able to figure out their own solutions as they write. You now have some an understanding of worry, an overview of the 3A Toolkit approach to managing worry, and some strategies in your helpful thinking and body calming strategy buckets. Next we will look at what we can put into your relationship strategies bucket.

Chapter 6: The Debrief—Rewind, Reflect, Rewrite and Replay “The secret of change is to focus all of your energy, not on fighting the old, but on building the new.” — Socrates

It will take time to learn to manage your anxiety well, and lots of practice. While you are developing your own personal 3A Toolkit that helps you to do this, you will still have moments when your anxiety feels too big. Little to no learning can occur at times of high activation or dysregulation, as the lower brain systems (mammal and reptile brain) are essentially in charge and a person has little access to their ‘thinking’ brain. However, a great deal of learning can occur once you have returned to a more calm and regulated state. Once you are calmer, you can debrief the anxiety episode and consider what you would do differently next time. It is really helpful to involve a supportive adult to help you with this also. How long it will take you to return to being calm and alert will vary considerably. Because we know that it is not possible to be connected (relationally) and highly dysregulated at the same time, your ability to socially engage with others lets you know you are likely ready to debrief a situation. This is another reason why it can be really beneficial to have someone help you with this process. In a debrief, work through the awareness, assign a label, and action areas of the 3A Toolkit. Consider what you noticed (Awareness), generate a label (Assign a Label), and determine what you would do differently next time (Action) in terms of the four categories of strategies. As I mentioned already, you always need a helpful thinking and body calming strategy. If your worry still needs additional strategies, then try a relationship or emotion and memory strategy. After this, imagine that you rewind the experience back to when you first noticed being worried. Then go through the Awareness, Assign a Label, and Action phases, but this time with the new ending where you imagine you have successfully shrunk your worry. Really notice how much more regulated you feel when you do this and notice and feel how different this is from when worry takes over. When you activate a memory like this, it is malleable and susceptible to revision, creating the opportunity to modify the memory in a positive way (Tryon & McKay, 2008). This is an incredible opportunity for learning what it will be like to be able to manage your worry well. So, even if you are not able to always shrink your worry as it is happening, you always have the opportunity to do a rewind and debrief later. Try and do a debrief often as this really is an excellent way to improve your ability to manage your worry. You may notice that you often feel a bit activated or worried just by thinking about an experience when you were worried. This is really normal and part of the avoidance that is a huge part of worry. With this in mind, perhaps choose an experience of worry that is mild or not that intense for your first debrief practice. Just by remembering the experience of worry, you will sometimes feel like you are overwhelmed. This is why it works so well to use the debrief to write a new ending and consider a different outcome for the worry and also why it is important to start with a small and manageable experience in the beginning.

It is important to consider that building healthy habits to manage stress and anxiety will take time. Here are some things to think about when getting ready to do a debrief: • Change takes time, be patient. • Be curious and compassionate about your experience • Growth and change is supported by cycles of reflection and feedback.

How to create healthier habits? REWIND, REFLECT, REWRITE, REPLAY REWIND • When you are calm and safe, rewind to when it all started. • Approach with curiosity, like a scientist or a detective looking for clues. • Mindful and non-judgmental awareness • Find the moment you want to rewind to. This is often just before you really started to notice the anxiety. Anxiety does not just appear magically or randomly, it is preceded by events, thoughts, actions and interactions that contribute to it. This is the information that we are interested in-all of the different elements that contributed to your uncomfortable experience of anxiety. This information is important so you know what changes you can make. • You will notice that in the next section, Reflect, you will be asked some reflective questions to help you gather important information about what is contributing to your anxiety. Even though you have done a ‘Rewind’ so you can debrief a past experience of anxiety, some of reflective questions are asked in the present tense and some in the past tense. When you reflect back on an unpleasant experience, such as being anxious, you may feel like that experience is happening right now. When going through the reflective questions, consider what you remember about what happened before AND what you are noticing right now as you reflect.

REFLECT (using the 3A Toolkit) Awareness Awareness Category

Important Reflective Questions

Body Activation

What do I remember about my body’s response at the time? What do I notice about my body now? What was my level of activation then? What is my level of activation now?

Thinking

Is this thought helpful? Consider if the thought was helpful at the time and if you think it is helpful now.

Assign a Label What feeling label will you use to capture your experience? Also notice and label how you feel right now. Action Using your 3A Toolkit, decide what helpful thinking strategies and body calming strategies you could use next time you feel anxious. For example, for helpful thinking you might use some messages of safety such as “This feeling will pass” and “I am safe” and “there is no real danger here”. You may also try some helpful thoughts that focus on what you can influence and what makes you feel more capable such as “I prepared well for the presentation and will do the best I can”. For body calming, I might try using my breathing with long exhales or choose my favourite body calming strategy. REWRITE (Using the 3A Toolkit) Now put all the pieces together and write a new version of the experience or event but this time with you putting the 3A Toolkit into practice and imagining you are able to shrink your anxiety. Using the public speaking example from this workbook, here is an example of what a rewrite would look like using the 3A Toolkit. AWARENESS

ASSIGN A LABEL

ACTION

Thinking

Label It

Helpful Thinking

• “This is going to be a disaster” • Your thoughts are jumbled and not helpful • Notice these thoughts are not helpful

“That’s just my anxiety”

• Messages of safety e.g. “This feeling will pass”, “I am safe”, “no real danger here” • Helpful thinking with a focus on: Present moment Capability What you can influence e.g. “I prepared well for the presentation and will do the best I can”

Body Activation • Heart is racing, trouble catching your breath • Assess level of activation

Body Calming For low to medium level of activation try using your breath to lengthen your exhale and slow your breathing down. For higher levels of activation, use slow movement such as walking

REPLAY Rewind what happened to the same moment you selected for this debrief, but this time replay it and imagine or visualize the new ending. If you are comfortable, you may even want to close your eyes. I suggest that when you get to the Action section of your replay, you actually state the new helpful thoughts and actually do the body calming practices. You may need to rewind and replay a few times until you feel more confident. Letâ&#x20AC;&#x2122;s try out the debrief using the prompts above. Choose a recent experience when you felt anxious and consider the following: Once you have figured out what is important in the Awareness, Assign a Label, and Action categories for the debrief, rewind the anxious experience in your mind and run through it again as if it was a movie. This time, use the new learning from your debrief to visualize a different way of responding to your anxiety that will generate a new outcome. Practice rewinding and replaying this experience with the new learning from your 3A Toolkit several times until it feels comfortable. You can use this 3A Toolkit approach for the debrief every time you felt more anxious than you wanted to, or want to respond to stress differently. There really is a lot of potential for new learning in reflecting on your experience in this way and essentially writing a new ending. Just remember that reflecting on past experiences of being anxious can leave you feeling a bit anxious in the present. This is a good opportunity to practice using the strategies you have learned, but I suggest starting to practice this debrief process with an experience of anxiety that is relatively mild (e.g., not a panic attack). As you get more confident with this debrief process, you can try more intense experiences of anxiety. And also remember to wait until you are calm to try this debrief process. Some people find it helpful to draw what happened. If this is you, I have included a template for drawing a comic strip version of a debrief, followed by an example of what this looks like when it is complete.

3A Toolkit Comic Debrief I know my____________________________________ is acting up when: BODY What is my level of activation?

AWARENESS How do I know worry? Is too big?

THOUGHTS & IMAGES Are they helpful?

Then I said, “That’s just my___________________________________”

ASSIGN A LABEL What am I feeling?

I know I can shrink my _______________________________ by :

ACTION How do I shrink the feeling?

HELPFUL THINKING

BODY CALMING

3A Toolkit Comic Debrief Example I know my_______Worry_______is acting up when:

AWARENESS How do I know worry? Is too big?

THOUGHTS & IMAGES Are they helpful?

I keep thinking something terrible will happen during my presentation and I will make a fool of myself.

BODY What is my level of activation? I feel nauseous and like my stomach is in knots. My heart is pounding and my hands are sweaty.

ASSIGN A LABEL What am I feeling?

Then I said, “That’s just my_____Worry____” I feel worried.

I know I can shrink my_____Worry____by:

ACTION How do I shrink the feeling?

HELPFUL THINKING “I am safe” “My worry is making up stories again”

BODY CALMING Deep breaths Butterfly hug

Chapter 7: From Avoidance to Approach Life can only be understood backwards; but it must be lived forwards.” — Søren Kierkegaard Avoidance A big component of anxiety is avoidance. It makes sense that you would want to avoid something that feels terrible, like anxiety does. Avoiding situations where you tend to be highly anxious leaves you feeling like your world is getting smaller, but it does lead to a short-term relief. The big challenge with avoidance over time though is that you end up making the anxiety stronger. In a way, it is like you confirmed the theory the anxiety had about something being dangerous by avoiding it. For example, imagine that you are anxious about public speaking so you avoid all public speaking. You feel better in the short term as you don’t have to face an uncomfortable and challenging situation, but you strengthen your anxiety over time. It is almost as if your anxiety had a theory that public speaking is scary and dangerous and you will be unsafe if you do it. By avoiding public speaking, you told your anxiety, “see, it was really scary and I am only safe if I avoid this”. This in turn makes your anxiety stronger for next time. Approach The antidote is to approach the situations that tend to elicit an anxious response. So, continuing with the public speaking example, you will need to practice public speaking. The key to being able to do this is to start with a situation that is only mildly uncomfortable and work your way up to bigger challenges. You can only do this if you have strategies to manage and shrink your anxious response. This is why we are only talking about avoidance, approach, and challenges at the end of the workbook. A couple of things will really help you be able to engage in approach behaviour. You will need to be able to build a challenge ladder and you will need to be able to imagine future success. Challenge Ladders Building a challenge ladder is a kind of exposure to challenging situations. Essentially, you choose a situation that is only mildly anxiety inducing to start with and build up to a challenge that is more difficult over time. The main point here is to move from avoidance of all situations that tend to fuel your anxiety to being able to approach them, as this is an essential part of being able to manage your anxiety. On the next page, I will show you an example of what a completed challenge ladder might look like for the person who struggles with public speaking. I will also include a blank ladder so you can fill in your own. You won’t necessarily climb up the ladder in a linear manner, there will likely be some up and down. That is normal, just keep considering what your next challenge is that will keep you moving up the ladder. Also remember that your 3A Toolkit will help you manage your anxious response so you can keep moving up the ladder.

Example of a Challenge Ladder:

Present in front of a large audience

Really challenging

Present in front of a small audience Present to your boss at work Present to one or two people at work Present to one or two people you know that are friends or family

Somewhat challenging

A bit challenging

Ask a question in a meeting

Blank Challenge Ladder for You to Complete:

Really challenging

Somewhat challenging

A bit challenging

Imagining Future Success After you have filled in your challenge ladder and before you start to complete the challenges, an important practice is to imagine future success. This is basically the opposite of the debrief. Instead of rewinding and reflecting on an experience of anxiety that has already happened, this time you will fast forward and imagine a situation that has not yet happened and anticipate how your anxiety might show up. Using the 3A Toolkit, you will then reflect on what you will notice (Awareness), what label captures the experience (Assign a Label), and what you will do to manage the worry (Action). You will then rewind this scenario and replay it until you feel like you will be able to manage the worry. This kind of If….Then practice helps prime and prepare yourself to use the strategies you have been practicing and boost your confidence about being able to manage your anxiety. For example, you might think to yourself “If I feel short of breath, then I will use figure 8 breathing to regulate by breathing”. I suggest using this process for each of the challenges on your challenge ladder. Here is a summary of what this process entails: Future Success: Fast Forward, Reflect, Write a story of success, Replay To practice this, let’s work through an example. Fast Forward • When you are calm, fast forward to a situation that you expect will induce anxiety. • Approach with curiousity, like a scientist or a detective looking for clues. • Mindful and non-judgmental awareness REFLECT (using the 3A Toolkit) Awareness

Awareness Category

Important Reflective Questions

Thinking

Is this thought helpful? Consider if the thought was helpful at the time and if you think it is helpful now.

Body Activation

What do I remember about my body’s response at the time? What do I notice about my body now? What was my level of activation then? What is my level of activation now?

Assign a Label What feeling label will you use to capture your anticipated experience? Action Using your 3A Toolkit, decide what strategies will work to shrink your worry. AWARENESS

ASSIGN A LABEL

ACTION

Thinking

Label It

Helpful Thinking

• “This is going to be a disaster” • Your thoughts are jumbled and not helpful • Notice these thoughts are not helpful

“That’s just my anxiety”

• Messages of safety e.g. “This feeling will pass”, “I am safe”, “I can do this” • Helpful thinking with a focus on: Present moment Capability What you can influence e.g. “I prepared well for the presentation and will do the best I can”

Body Activation • Heart is racing, trouble catching your breath • Assess level of activation

Body Calming For low to medium level of activation try using your breath to lengthen your exhale and slow your breathing down. For higher levels of activation, use slow movement such as walking

Write a Story of Success (Using the 3A Toolkit) Now put all the pieces together and write a version of the anticipated experience or event but this time with you putting the 3A Toolkit into practice and imagining you are able to manage your anxiety. The story of success focuses on shrinking the anxiety, not on trying to control circumstances outside of your influence. For example, if you are imaging managing your anxiety about public speaking, you focus on calming your body and helpful thinking and not on everyone in the audience clapping for you or even not making any mistakes (you are obviously hoping this will happen but cannot not completely control this).

REPLAY Rewind the scenario to the beginning, but this time replay it and imagine or visualize the successful ending with you managing the worry. This way, you are not only wishing and hoping that you won’t be anxious (this does not usually work), you are expecting some anxiety and you are ready for it! Using your 3A Toolkit, continue to set challenges using your ladder, use the future success visualization to prepare for the challenge, and use your debrief to consider that you can do differently for next time. This is a recursive process of reflecting on what happened, providing yourself with feedback about what you can change for next time (with respect to thinking in a more helpful way and calming your body), and visualizing enacting that change. Over time, this process will really support improvements in your ability to manage your stress and anxiety. You now have your own 3A Toolkit that you have filled in with the strategies that work best for you. Instead of a list that will only work once, you now have a complete 3A Toolkit that has equipped you to understand what is happening in your brain and your body when dealing with stress, worry, and anxiety. You also know what to do when you were not able to manage your response in the moment – you can always do a debrief after the fact. And you are equipped to counter an instinct to avoid situations that cause anxiety with your challenge ladder and ability to systematically visualize future success. You have made amazing progress so far. Let’s proceed to Part Two of this workbook. Part Two will provide some additional knowledge and strategies for those of you who are looking for additional tools and understanding regarding managing your anxiety.

Creating Calm The 3A Toolkit Approach to Shrinking Stress and Anxiety ADULT EDITION

PART TWO: THE EXTRAS

Congratulations, you have completed Part One of the Workbook and now have your very own 3A Toolkit to help you to manage your anxiety. You have a good understanding of how to collect information (Awareness) about your anxiety, how to organize this information (Assign a Label), and how to respond to this information (Action). You also know how to rewind past anxiety with a Debrief and plan for future success using your 3A Toolkit. For some of you, this may be enough, you may already feel like you are well on your way to managing your anxiety. Others may still be interested in some additional information. Part Two will introduce you to how relationships, emotion, and memory may play a role in your experience of anxiety. This may be of interest for those of you who are facing more complex mental health challenges, have a dealt with traumatic events in the past, and have not had the supportive relationships you need. If this is you, your anxiety may be more challenging to manage and may really benefit from the additional information in this section. Even if this is not you, the section will still be useful and may give you some additional ways of managing your anxiety.

Chapter 8: Relationship Strategies “You can’t always control what goes on outside. But you can always control what goes on inside.” — Wayne Dyer

When we were going over the plan for shrinking anxiety, the 3A Toolkit, I introduced you to the idea that all of us exist in relationships with others and with ourselves. None of us are truly ever in isolation, we really are relational creatures. For this reason, considering relationships is always helpful as part of managing worry and anxiety and for overall wellbeing. Relationships are often complex and we will not be able to address all aspects of relationships in this workbook or solve all of your relationship challenges. If you are really struggling with relationships, I suggest finding someone such as a helping professional to speak with in more depth about this. For this workbook, I will introduce you to a few helpful ideas and practices to help you with your relationship with others and yourself. Interpersonal Relationships (Others) Collecting information about relationships in order to understand your worry or anxiety includes present relationships as well as historical ones, both good and bad. Relationships have the potential to foster regulation and help you to cope and feel better. When relationships are supportive, they can help you to regulate your worry. When relationships are unsafe or unhealthy, they can fuel dysregulation and related challenges. Consider how your level of anxiety changes depending on the people in your life. It is beyond the scope of this workbook to explore your relationship history and present relationships in detail, just know that they are important. Also, if you have a history of difficult relationships, especially in your family growing up, it may take a bit longer to manage your anxiety and to understand how these relationships impact you. Part of how you manage stress and anxiety is learned from the important people around you. Some of the important people around you are good at managing stress and anxiety and others are not. They may not have had the opportunity to learn the strategies you are learning in this workbook. I mention this to encourage you to be kind and compassionate to yourself and others around you and know that learning to manage stress and anxiety is possible. Boundaries. As best you can, try and surround yourself with people who are supportive and who want the best for you. I know that this is not always easy to do. You may also need some practice with setting boundaries in order to take care of yourself and your energy. Think of boundaries as kind of like a property line that keeps unwanted intruders out and you safe. This might mean that you risk disappointing others when you say no sometimes, but it also means you are caring for and standing up for yourself. Setting boundaries is a way of confirming that you are worth protecting and looking after. Very simply, boundaries are “simply our lists of what’s okay and not okay” and keep you from feeling resentment (from Brene Brown’s Rising Strong, 2015). To learn to set boundaries, which will take practice, Brene Brown suggests the following:

Make a mantra: choose a phrase that reminds you to make a choice that promotes your wellbeing. Keep a resentment journal: write down when you are feeling resentment, this is often when you are overwhelmed and tired and probably not setting boundaries. This will help you understand and develop insight into where you need to develop new or stronger boundaries. Rehearse: Practice saying no: practice with your pet, with yourself, and with others; practice a lot. Setting boundaries can be really hard, so be kind to yourself as you figure this out. Know you are worth protecting and taking care of! Even though learning to set boundaries can promote wellbeing, learning to do so can be accompanied by some stress in the short term. Intrapersonal Relationships (Self) How a person relates to themselves is very impactful and has a great deal of influence over stress, worry, and anxiety. A negative and critical way of relating to oneself is common in individuals who experience anxiety. Consider how you relate to yourself: How do your respond when you make a mistake? How do you speak to yourself? It is common for those with anxiety to be kind to others, to be encouraging and supportive of other people who are struggling or who make a mistake. Yet this same kindness and compassion is not offered to yourself. Learning to be compassionate towards yourself, also called self-compassion, is an important part of regulating stress, worry and anxiety. There are three elements to self-compassion which are: (Kristin Neff, 2011) 1. Self-kindness vs. Self-judgment Self-compassion involves being warm and kind to ourselves, even when we make mistakes. This is in contrast to judging ourselves harshly, beating ourselves up. 2. Common humanity versus Isolation Self-compassion includes the recognition that part of being human is that we are vulnerable and we suffer. We share this experience with other humans. This is in contrast to feeling alone and isolated and that we are the only one who is struggling. 3. Mindfulness vs. Over-identification Self-compassion includes noticing our experience without judgement or avoidance.

Even if you are not sure how to change your relationships with other people, or you need to meet with a helping professional to assist you with this, you can always take a look at how you relate to yourself. If you are someone who is hard on yourself, or beats yourself up verbally, developing self-compassion is hard to do. Just start somewhere. Even if it is a very small step, it is still a step in the right direction. For example, you may only be comfortable with a neutral statement to yourself like “I’m trying” and that is as kind as you can be to yourself. If you are really struggling with self-compassion, start with the general idea that people deserve to be healthy and well. Start wherever you can and continue to work on how you relate to yourself. You can even think about how you treat someone you really care about, especially someone who is struggling; write down how you would help them and take care of them. Then read out what you have written and imagine if you could offer this same kindness to yourself. Relationship Awareness How we relate to ourselves (Self - intrapersonal relationships) and how we relate to others (Others - interpersonal relationships) are essential components of the fabric of wellness and are foundational in the human experience. Our need to connect with others is wired into our very existence. As humans, we exist in relation to ourselves and others. We are never in a vacuum devoid of inter- and intra-personal connections. For this reason, managing stress and anxiety benefits from considering relationships. Here are some questions that will help you to be aware of your relationships.

Interpersonal Relationships (Others) Is this relationship supportive? How can I strengthen existing relationships and/or develop new ones that are supportive? How are my boundaries? Intrapersonal Relationships (Self) How am I relating to myself? How can I be more supportive and compassionate to myself?

Chapter 9: Strategies to Manage Emotion & Memory “There can be no transforming of darkness into light and of apathy into movement without emotion.” — Carl Jung Emotion Emotions are a type of information processing that includes your mind, body, and relationships. Emotions orient you to yourself and your environment, as well as get you prepared to respond. Emotions are fairly complex as they are shaped by your history or past experience as well as your present experience. A feeling is the cognitive label we give to the mind and body experience of emotion. For our purpose here, consider that emotions are information. The emotions themselves are always valid and provide us with clues to self-understanding. In general terms, negative emotions drain our resources, narrow our focus, and tune us into threats and survival concerns. Positive emotions foster integration and regulation, broaden our perspective, and orient us to other people. Emotions involve both our brain and body. Most important is to mindfully notice what emotion is present. Through being aware of the emotion and being curious about it, you will create space to decide how to respond. When you are not aware of what emotion is present, you will be more likely to react without intention. This workbook is focused on the emotion of anxiety, but of course you will be experiencing many other emotions throughout your day and as you tackle your worry. Part of a strong foundation (e.g., see chapter 2) and a protective factor for anxiety is to grow positive emotion. You can do this at the same time as you are working on shrinking your worry. A negative emotion like worry will tend to take over and eclipse positive emotion. For this reason, it will be very helpful for you to pay attention to and create room for more positive emotion. I will provide a few practices that can help grow positive emotion in the next section. It is very common to want to avoid negative emotions because they are usually not very pleasant. This doesn’t work very well though, and can even help the negative emotions ‘stick’ around longer. Instead, try the following when you notice negative or challenging emotions: • Notice what is already there (e.g., “I feel sad/worried/unhappy….”) • Turn towards the emotion • Turn towards yourself with an act of kindness Growing positive emotion is especially important when you are struggling with stress, worry, and anxiety because you may not notice the good things as these are overshadowed by what you are worrying about. There are many ways to grow positive emotion, and there has been some really wonderful research in this area in recent years. If you are interested in learning more about this, an excellent website is hosted by the Greater Good Science Center from UC Berkeley (https://ggia.berkeley.edu ). You will find many helpful ideas here.

Here are a few ways you can grow positive emotion: Add smiles: intentionally smile in places you would not normally Notice the good: pay attention to good things that happen. These can be very small and concrete things that you would not normally notice. For example, if you stop to have a soothing cup of tea, notice this and bring your attention to all the positive aspects of that. Or really pay attention to a nice flower as you are walking along. We don’t need to work on noticing the bad or the negative, by directing your focus to good things, you notice things that you otherwise would not have paid attention to. Gratitudes: At the end of each day, recall things you are grateful for from that day. Like when you notice the good moments in life, the things you are grateful for can be small and concrete. HEAL: Dr. Rick Hanson (from Hardwiring Happiness: The New Brain Science of Contentment, Calm, and Confidence) developed the acronym HEAL for noticing the good things. HEAL stands for: Have a good experience Enrich it Absorb it Link positive and negative material

Here are the four steps in a bit more detail: STEP 1 (H): Notice a positive event or experience and bring your full attention to it, letting yourself feel good. STEP 2 (E): Stay with the positive experience for 10 to 20 seconds. Be open to how this feels and sense it in your body. STEP 3 (A): Grow and absorb the experience by attending to it with all of your senses. STEP 4 (L): Important note: the L is optional, I suggest you approach this step with some caution. The idea here is to keep the positive experience in the foreground and link to a negative experience in the background. If the negative experience, which is often very strong, takes you out of the positive experience, return to a focus on only the positive. The idea here is to be able to integrate the positive and negative, in effect to mix them together and link these very different experiences. By doing this, you take the ‘power’ away from the negative experience, so that it is not able to overwhelm you. When you can keep the positive and negative in your attention at the same time, you will have a broader perspective. This can be hard to do given how much negative experiences tend to grab our attention and narrow our focus.

Memory Implicit and Explicit Memory When talking about memories, we usually mean explicit memories. An explicit memory is when you can remember all the details of an experience including what happened, the sensations that you associate with this experience, and when it happened. In other words, an explicit memory is when the story of what happened is connected to the time stamp and the sensory information. We also have memories that we are not consciously aware of. Another way to think about this is that three important elements of memory are not connected; a) the time stamp or when it happened, b) the story of what happened or chronology of events, and c) the sensory information are not connected. These are called implicit memories. Implicit memories are often from when we were younger than age 5 or from traumatic or overwhelming experiences. These memories can really impact us, even impacting how we feel, think, and act. But we don’t know when we are remembering this kind of memory as the details are separated from the sensory information and when it happened. We are often left with just the sensory information. For example, you may feel anxious and notice your heart pounding without knowing what caused this. When learning to manage anxiety, you don’t need to think about which are explicit or implicit memories, you will likely not be able to put all these pieces of your history together and you really don’t need to. This information about memory is helpful because it shows you that there is not always a strong present moment logical reason for the anxiety to be there. You can spend a lot of time wondering why you are anxious and trying to use logic to talk yourself out of feeling anxious. This approach does not work that well because anxiety originates from brain systems that are not logical, they are interested in survival. Your anxiety may have been shaped by implicit experiences which will often feel like only sensory information that may connect to past experiences as much as present. I am providing you with this information to help challenge the idea that anxiety has a good reason to be there and that you need to figure out why it is present. Your anxiety may be shaped as much by your history, even history you are not able to remember, and you do not need to figure this out in order to start to manage your anxiety. You are better served to focus on your present experience of anxiety and respond to what is here right now. Some aspects of your experience and history that are worth exploring in greater depth, perhaps in a therapeutic setting, are challenges within family relationships and traumatic experiences that you have had. This kind of inquiry is beyond the scope of this workbook but I want to let you know that these are factors that can add additional challenges to learning regulate your anxiety and responses to stress. You can also use memories as a helpful intervention. The Calm Place practice is a good example of this. Calm Place: In addition to self-compassion, part of developing a healthy relationship with yourself includes feeling calm and safe. Worry and anxiety leave your feeling unsafe. A practice that can help develop the ability to feel more calm with your own experience is to think about a time and a place when you felt really calm, comfortable, and safe. This might be a place you visited like a beach, or another natural setting, or perhaps your own home. As you think about this

place, close your eyes and consider in detail what you see. If you are not comfortable closing your eyes, let your gaze softly settle just in front of you. Imagine looking around and taking in all the details. Then turn your attention to what you can hear, noticing all the sounds that are unique to this place. Now consider what you can smell, turning your attention to all the smells that your notice when you are in this place. What about what you can taste, if that is something that you notice when you think of this place. Finally, consider what you feel and what you notice in your body as you revisit this place in your mind. Bring your full attention to where you notice the calm, comfortable, safe, and pleasant sensations in your body. When you are ready, open your eyes and return to this time and place and remember that you can return to your calm place whenever you like. You may want to practice more of this kind of visualization where you go to a positive experience and recall it using all of the sensory information available. You may also want to draw a picture of your calm place to help your recall the details. For some people, especially if you have experienced trauma or other very difficult experiences, reflecting on memories can be overwhelming. Only use the memory strategy if it is comfortable for you. Intense emotional experiences like anxiety hook your attention and you can remain stuck on that ‘negative channel’. It takes practice to notice and be mindful of intense emotions and learn to switch from a ‘negative channel’ to a more positive one like you did in the calm place practice. This chapter introduced you to being curious about your emotional experience, developing the capacity to mindfully observe your emotions and to intentionally tap into memories of feeling calm to help shift your experience when faced with anxiety. In the next chapter, we will start to pull together the three sections of the 3A Toolkit, Awareness, Assessment, and Action, so you can start to see the 3A Toolkit in action and get closer to managing your anxiety. Awareness of Emotion & Memory Here are some questions that will help you be aware of how emotion and memory shape your experience of anxiety: Emotion What information does this emotion provide? What can I do to experience more positive emotion? Memory What is another time when I felt like this? What is a positive memory I can recall to help redirect my attention away from the anxiety? Summary I hope that you have found this information in this section on relationships, emotion, and memory interesting and helpful. I want to remind you that changing personal habits and patterns is really hard and takes time. With this in mind, try to be kind to yourself and recognize that this kind of change is a process that unfolds over time and has ups and downs. Really look for the positive changes you make and recognize your effort and persistence. In the next section, Part Three: Planning Ahead, we will look at a few more things that will help keep up the progress you have made. 70

Creating Calm The 3A Toolkit Approach to Shrinking Stress and Worry ADULT EDITION

PART THREE: PLANNING AHEAD You now have being using your 3A Toolkit to manage your anxiety and are likely continuing to collect information about how relationships, emotions, and memory support your wellbeing and impact your anxiety. You have worked very hard to get to this point and I hope you take a moment to appreciate your effort and willingness to engage in reflection and change in this way. The final section of the workbook shifts to considering how we can keep the positive changes you have made going.

Chapter 10: Planning Ahead “Life is like riding a bicycle, to keep your balance you must keep moving” — Einstein We have now gone over the 3A Toolkit for managing anxiety or worry and we will now finish putting together your personal 3A Toolkit that highlights the strategies that are most helpful for you. You have already been considering what works for you by noticing your own experience of stress and anxiety (Awareness), you have learned to label this experience (Assign a Label), and have been practicing strategies from all four categories (Action) to manage your response to stress and anxiety. You have also learned that even when you are not able to manage the anxiety or stress in the moment, you can still learn a lot after the fact by going through the debrief. By continuing to practice working on the Awareness, Assign a Label, and Action components of the 3A Toolkit, you will develop the capacity to regulate your response to stress and anxiety. Your Own 3A Toolkit You now have all the pieces to assemble your own 3A Toolkit. Let’s first review the overall plan for shrinking worry: Then let’s look at what a filled in 3A Toolkit might look like:

3A Toolkit

AWARENESS

(Collecting information)

TOP-DOWN

ASSIGN A LABEL

(Organizing information)

MINDFULNESS AWARENESS THINKING

SELECT A FEELING LABEL FOR YOUR EXPERIENCE

“Is this thought helpful?”

“I feel

”

BODY ACTIVATION • What do you notice about your body?

ACTION

(Responding to the Information) HELPFUL THINKING Messages of safety • “I can get through this” • “This feeling will pass” • “Thank you for trying ot help me Mr. Worry but I am safe” Focus on helpful thoughts: • Capable • Things you can influence • Present moment

• What is your level of activation?

BODY CALMING Levels of activation 0-5 • Breathing • Figure 8 breathing • Tummy clench and release • Butterfly hug • Orienting • Grounding

5-10 • Exerciseslow and deliberate • Movement • Finger pushups • Bilateral movement • Shaking

From reading through this workbook and practicing the strategies, you will have ideas of your own about what strategies will work for you. Here is a blank 3A Toolkit for you to complete with what will work best for you:

3A Toolkit

AWARENESS

(Collecting information) THINKING

TOP-DOWN

ASSIGN A LABEL

(Organizing information) NAME IT TO TAME IT

BODY ACTIVATION

ACTION

(Responding to the Information) HELPFUL THINKING

BODY CALMING

Resilience Learning to manage your responses to stress and anxiety will not happen right away. With practice, you really will be able to better regulate your responses to stress and anxiety and achieve better integration and wellness. Through managing your stress and anxiety, you are also building your resilience. Resilience is the ability to bounce back and recover more quickly from worry and other challenges. To help explain this, consider a concept from neuroscience called the window of tolerance (Daniel Siegel, 2010). This is the range within which you feel like you can manage the challenges in your life, the ups and the downs. On either side of this window, you have hyperarousal (e.g., anger, anxiety, stress, frustration) and hypoarousal (e.g., sadness, depression, fatigue, numb, unmotivated). Anxiety, worry, and stress are on the hyperarousal side of the window. Every time your return from hyperarousal back to your window of tolerance (feeling regulated and calm), you widen your window and increase the range within which you can manage challenges. This is

resilience, the ability to recover from challenges. Over time, through following the 3A Toolkit framework, you will learn to manage stress and anxiety and build your resilience through widening your window of tolerance, which you do every time you shrink your worry using your 3A Toolkit. Window of Tolerance

Hyperarousal

Optimal arousal (window of tolerance)

Hypoarousal

Increased sensations, emotionally reactive, hypervigilant, intrusive imagery/thoughts, disorganized thinking, anxiety, stress, anger Chaos

Emotions are tolerable, attentive and able to learn Integrated Regulated

Relative absence of sensation, numbing of emotions, disabled thinking, reduced physical movement Rigidity

Planning Ahead Now you have a good understanding of stress and anxiety as well as your own 3A Toolkit for managing your responses for stress and anxiety. Consider how you can make time to practice the strategies that are working for you. Consider the time of day that works best for practice, reminders, and perhaps involving a supportive friend or family member to practice with you. Remember to use the debrief process to rewind any experiences of anxiety and stress that you want to manage differently, and consider the strategies you want to use next time. What strategies will you practice most often and when?

On the next couple of pages, there is the sample 3A Toolkit to review the approach and a blank 3A Toolkit for you to complete for yourself. I am grateful to be able to share this approach with you and wish you all the best as you learn to manage your stress and anxiety. What You Can and Cannot Influence It is really helpful to note the difference between all the things you can influence and all the things you cannot. Putting energy, conscious or not, into factors that are outside of your influence can really drain your resources, which is not helpful for managing stress and anxiety well. You certainly may feel sadness, loss, anger and many other things about aspects of your life that are outside of your influence. Notice the feeling as it is already there, and treat yourself with kindness and compassion as you care for the feeling and yourself. And follow this up with shifting your energy and attention to aspects of your life that you are able to influence. Below is a simple diagram to help you explore some of the things in your life that you can influence and some that you cannot. A few examples are listed to get you started but you will want to add many more of your own.

What other people think What other people do What other people say Past mistakes Weather Height

My response to stress and anxiety Healthy habits Being kind Working hard Asking for help

Healthy Habits Being healthy involves keeping a balance between aspects that are important to healthy functioning bodies and brains. The following are examples of areas of your life to try and balance in order to be healthy, in addition to the healthy habits you have already learned with respect to your foundation of mental health and about thinking, body calming, relationships, emotion, and memory. Consider how you are doing in each of these areas and whether you can make any small changes to move you in a positive direction (note: adapted from The Yes Brain by Daniel Siegel and Tina Payne Brysen). Sleep We need adequate and regular sleep in order for our brains and bodies to recover and have enough resources to deal with challenges. Sleep also helps us consolidate learning. Exercise We need exercise for both our physical and mental health. Consider your exercise habits and what kind of exercise helps you to feel better. Social We are social creatures and benefit from quality interactions with other people, in person if possible. This helps us feel supported and resourced in order to tackle the challenges of our day. Play At all ages, we benefit from being creative and trying new things. Consider what you really enjoy doing and how you can create time in your life for fun and enjoyment. Rest and relaxation We need time to be idle with no particular purpose some of the time. This can help our brain recharge, especially our thinking brain. Goals All of us have things we need to do related to school, work, and running our lives. Tackling goals and challenge help us feel capable and accomplished. Nature Spending time outside and if possible, in nature, helps keep our brains and bodies healthy. Reflection, Contemplation, Integration Time to reflect on, contemplate, and integrate your experiences and ideas. You need time to make sense of things and decide what they mean for you and your life.

The Nature of Change “There is nothing permanent except change” —Heraclitus As part of planning ahead, it is helpful to contemplate change itself. Learning to manage and shrink your anxiety involves considerable change. It involves changing your behaviour from avoidance to approach, it involves changing to more helpful thinking, it involves changing how your relate to yourself and possibly others, it involves changing how your body responds to stress and anxiety, and it involves changing how your relate to your own feelings and memories. Most of all, it involves changing how you relate to anxiety itself. In a way, you have been practicing being anxious for a long time, although not on purpose. To quote neuropsychologist Donald Hebb “neurons that fire together wire together” (1949). What this means is that you have strong neural pathways that support your anxious response. To develop new neural pathways will take time and lots of practice, but it is definitely possible according to research on neuroplasticity. Neuroplasticity is the brain’s ability to change and adapt throughout our life. This is excellent news for you as you learn a new way of relating to your anxiety and a new way of responding more intentionally, instead of automatically reacting, to stress. Consider your experience and history with change, from small changes, such as going to bed earlier, to large changes, such as education or career shifts. Be curious about what assumptions and expectations about change you hold from your past successes and challenges with change. Consider what assumptions and expectations you might have about learning to manage your anxiety. These assumptions and expectations really are a kind of thinking that operates beneath our awareness but can really influence you. Just as you have learned to do with thinking related to anxiety, ask yourself “is this helpful?”. You may have assumptions and expectations about change that don’t serve you well. Once you notice these, consider if you can challenge them and perhaps replace them with new expectations for learning to manage anxiety. Finally, your progress will not be in a straight line. Learning to manage and shrink anxiety and worry takes time, energy, and a lot of practice. You will be better at this some days than others, there will be ups and downs along the way. When you hit a bump in the road, remember all the positive steps and progress you have made, and reflect on all the pieces of your strong and stable foundation from chapter 2. Most of all, I am really proud of how hard you have worked to get this far. Thank you for letting me join you on this path towards managing your anxiety.

Thank You!

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Creating Calm: 3A Toolkit for Managing Stress and Anxiety- Adult Edition

Articles inside

REFERENCES

CHAPTER 10: Planning Ahead

PART THREE: WHAT’S NEXT?

CHAPTER 9: Strategies to Manage Emotion and Memory

CHAPTER 1: What is Worry?

CHAPTER 7: From Avoidance to Approach

CHAPTER 4: Strategies for Body Regulation

CHAPTER 8: Relationship Strategies

CHAPTER 2: Your Foundation

CHAPTER 6: The Debrief—Rewind, Reflect, Rewrite and Replay

PART TWO: THE EXTRAS

PART ONE: THE ESSENTIALS