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

CREATING CALM 3A Toolkit for Managing Stress and Anxiety Ad YO U T H E D I T I O N

Meg Kapil ma , ccc - s , rcc

CONTENTS

CHAPTER 1: What is stress and anxiety?

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CHAPTER 2: Your Foundation

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CHAPTER 3: The 3A Toolkit Plan for Managing Worry

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CHAPTER 4: Strategies for Body Calming

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CHAPTER 5: Strategies for Helpful Thinking

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CHAPTER 6: Relationship Strategies

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CHAPTER 7: The Debrief—Rewind, Reflect, Rewrite and Replay

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CHAPTER 8: From Avoidance to Approach

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CHAPTER 9: Planning Ahead

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REFERENCES 78

CREATING CALM Shrinking Stress and Worry

YO U T H E D I T I O N

CHAPTER 1

What are stress and anxiety?

Today is the day you have to do your presentation in front of the class. You were hoping your teacher and your parents would forget and you wouldn’t have to do it. You know a lot about your topic, that isn’t the problem. You could talk about it all day with your family! When you think about standing up in front of the class, everyone looking at you, you can hardly remember your name and you really can’t remember what you were going to say. It’s like someone took all of your thoughts and blended them up. It feels harder to breath and you feel a bit sick, your stomach is full of knots, and your hands feel sweaty. You think to yourself “what is wrong with me, why can’t I get it together, everybody else is able to do their speech”. Your teacher and parents tell you it will all work out and that you can do it, except that really really really does not feel true. And most of all, you feel like there is nothing you can do to change how you feel.

You might have the same worry as the example above or a totally different worry, pretty much everybody has worries about something. A little bit of worry or stress is normal and even if we don’t like how it makes us feel, we can handle it. Sometimes worry gets too big, so big that it gets in the way of doing things you want to; like doing a speech at school, going to an event, trying out for a sports team or even going to sleep easily. When worry gets in the way of doing the things we want to, then it is time to do something about it.

This workbook is going to help you do just that! We are going to learn about what worry is and most importantly, we are going make a toolkit just for you so you can manage your worry and get back to doing all the things you want to.

WHAT IS STRESS? Stress is a normal or reasonable response to a situation that makes you a bit uncomfortable such as a performance or a new experience. Stress usually goes away when the situation causing the

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stress is also gone. A bit of stress can even be helpful, you might perform better in a competition or for a school presentation for example. The reactions in your body that result from stress are similar to worry and I will explain more about this later. You will notice that the words stress, worry, and anxiety are often used for the same thing. They are not exactly the same thing though. An easy way to understand how they are different is to think of stress as having an obvious cause and getting better if you take the cause of the stress away. Worry and anxiety are different names for the same thing but worry is often a bit smaller and anxiety is the formal label that a doctor or psychologist might use. While these different names can be confusing, they all refer to the same responses in the body and brain.

WHAT IS ANXIETY? Anxiety, sometimes also called worry, is a response in our body and our brain that happens when your mind assumes there is some kind of threat or danger. Anxiety is like a defense system that is turned on to help keep you safe from physical danger. The problem with worry is that this system is turned on when there is no actual danger present. All the uncomfortable feelings in your body and the trouble you have thinking clearly would make a lot of sense if you were actually facing real physical danger. For example, imagine that you actually come face to face with a tiger (I really hope this doesn’t happen because this would be very scary and dangerous). If this actually happened, you would want your automatic defense system to help you react really fast to keep you safe.

So the system that is responsible for all the unpleasant feelings in your body and the trouble you have thinking when you are stressed and worried, is the same system that keeps you alive!

For this reason, we don’t actually want to get rid of worry completely, because we really need this system so we can deal with actual danger. The problem with worry is that your defense system is too good at it’s job, kind of like it is protecting you from tigers that are not actually there. When your defense system detects a threat or danger, this does not have to be a ‘real’ physical threat, the defense system is turned on and you feel like you are fighting tigers or something else life threatening. So, what we’ll work on together in this workbook, is retraining your defense system to not fight tigers that are not really there. In other words, you are going to learn how to manage your worry, a bit like you are shrinking it down to a much more tolerable size.

When your worry response is turned on, here are some of the things you might notice:

ACTIONS

FEELINGS

• Avoid tasks or activities and people that you associate with worry.

• Withdrawal from activities or trying things that might bring on worry.

• Big reactions or outbursts such as anger and crying that you don’t feel like you have any control over.

• Fear • Worry • Frustration • Panic • Overwhelmed • Dread • Self-doubt

THINKING • Thoughts that are not helpful such as thinking about things only turning out badly.

• Stuck thinking about the same thing over and over again.

• Thinking about not being safe.

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SOCIAL • Spending more time on your own and away from friends.

• Being really tough on yourself.

PHYSICAL • Fast and shallow breathing.

• Heart is beating really fast.

• Sweaty palms.

• Face gets flushed.

• Stomach is uncomfortable.

• Fists cleanched.

• Shaking muscles.

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The above examples may not be exactly what happens when you are worried, or some of the responses 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. List below the things that you notice about your experience of anxiety:

ACTIONS

FEELINGS

THINKING

SOCIAL

PHYSICAL

For more information regarding anxiety see https://anxietycanada.com From filling in the chart above, you can see all the different ways worry impacts you. Now let’s learn more about what worry really is by learning about what happens in your brain and your body when you are worried.

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 extremely 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. This a simplified version of the brain. In reality, the brain is far more interconnected but the triune brain is a great model for understanding worry and strategies for managing it.

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THE TRIUNE BRAIN:

HUMAN MAMMAL REPTILE

Reptile Brain The first part of the triune brain we will talk about is the reptile brain. This is also the most ancient part of the brain, think of caveman ancestors, and the only part of the brain to be fully developed when you are born. It is responsible for all the functions we don’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 or defense system when you are afraid, worried or anxious. In fact, the main job of the reptile brain is survival, it is in charge of everything that keeps you alive and this includes worry. Worry really is a response that helps keep you alive in response to danger. 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

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FREEZE

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When your alarm response and reptilian brain is turned on, you are ready to deal with physical 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 even when it is not. For example, if you are worried about talking in front of the class like the example at the beginning, you won’t be physically harmed from doing that, but it sure feels like you will from how your body responds! This is because this part of the brain doesn’t know the difference between what is actually going to hurt you and something that is a bit uncomfortable. The response is the same for both.

This part of the brain also works without you knowing it is working and it works really fast. The reptile brain also takes over from other parts of the brain like the thinking brain. 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). Therefore we don’t want to get rid of the alarm system and the worries altogether, just understand and train them 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 mammal brain.

Mammal Brain The mammal brain or limbic system is complex and has many different parts. Only one part of the mammal brain will be explored in this worbook. Functions such as memory and emotion are also found in mammals which is why this part is called the mammal brain. For understanding stress and worry, we are interested in a very important part of the mammal brain, the amygdala. This is a bit hard to say so I will help you: “UH MIG DA LA” (Amygdala) Now that you have that sorted out, I will tell you what the amygdala does and how important it is for worry. The amygdala triggers emotional reponses such as anxiety or fear, and acts as your security guard or guard dog. It’s 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 is always looking for threat and when it finds what it perceives a threat, it turns on the reptile brain and the fight, flight or freeze response. Your amygdala collects information about what is a threat from a few places including your senses and what you think:

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THE SENSES

Your senses are:

TASTE

HEARING

SMELL

TOUCH

VISION

This 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 have a big worry reaction when you see one of these, even though you know most dogs and most audiences will not hurt you. An important part of learning to shrink worry will be learning to give the amygdala correct information that you are physically safe, no tigers are jumping out at you right now because the amygdala is not always right 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.

Thinking: The mammal brain and amygdala also get information from the human brain, the final part of the brain that we will talk about. Just know that what you are thinking can have an immediate impact on the amygdala and whether your alarm system is turned up or down. So, if you are thinking really negative thoughts, the amygdala will label this a threat and turn the alarm on or up even if there is no physical danger. An important part of learning how to shrink worry will be re-training the amygdala to recieve correct information, such as the feeling of safety. Since the amygdala is not always right about what it identifies as a threat, the rest of the defense system is turned on, and can cause worry when there is no real threat. The problem is that your reptile brain gets this information and acts the same way regardless of how real (or physically threatening) the perceived threat is. This is how you can have the similar level of alarm response or worry when delivering a public presentation as facing down an attack from an actual tiger (although I hope you don’t have any actual experience being attacked by tigers). Learning to manage worry will involve working with this alarm response so it is not ready to fight tigers that do not actually exist.

Human Brain The final part of the brain we will talk about is the human brain. We have already talked about it a bit when we were talking about how thinking can be labeled as a threat by the amygdala and turn on the defense system (also known as worry). The human brain is sometimes called the thinking brain or the professor brain, it is the ‘smart part’ and the newest part to develop in terms of evolution. Our caveman ancestors did not have very big thinking brains. We share this part of the brain with other humans and it is the last part to develop, even growing right into our 20’s. This part of the brain deals with a lot of information and is very helpful for figuring things out at school

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and when you’re playing sports. This part of the brain will be very important for being able to ‘train’ the amygdala and the whole defense system in your brain and body to be a bit less excited about fighting tigers all the time.

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 (Amygdala)

REPTILE Main job: Survival (Fight, Flight, 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. When we are worried, the bottom two parts of the brain (reptile and mammal) are too busy or excited which 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 it’s whole job is to focus on survival, like fighting tigers even when they are not there. What we will learn how to do to shrink the worry is to get the upstairs brain back in charge, to connect the upstairs and downstairs brain again, and 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) 8

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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

Mammal Brain

(Amygdala)

(Amygdala)

Reptile Brain

Reptile Brain

(Survival)

CALM

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

(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 Siegel’s Hand Model of the Brain found in Mindsight: The New Science of Personal Transformation (Bantam Books, 2010)

WHAT ABOUT ADOLESCENCE? You have probably heard many things about what it means to be an adolescent or a teenager, some good and some bad. I will give you a bit of information about a few of the many changes you are going through as you move through this life stage, some of these changes are fantastic and some leave you a bit vulnerable in terms of stress and anxiety. Adolescence is a time of incredible change in your brain and body which can give you an edge in terms of creativity, original ideas, trying new things, and being adventurous. Starting in middle school and throughout high school, you probably notice that your peers become more and more important. Healthy relationships with friends are important and you still really need to stay connected to supportive adults also to help you manage stress and anxiety. Having different people from different places on your team can really help. Stay connected to supportive adults if you can, they are very helpful when you need support to manage stress and anxiety.

There are also many changes happening in your brain during this time. You will experience hormonal changes that act on your limbic system and contributes to experiencing emotions

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more intensely than adults do. Adults use a rational part of their brain to read facial expressions while teens use the amydala, this primes teens to see others as a threat more than adults. Some hormones also have a different effect in teens. For example, the hormone THP is released in response to stress and calms adult brains but has the opposite effect on teens which can increase stress responses and leaves teens prone to anxiety. Your amygdala is very responsive during this time and picks up on perceived threat very easily, and may even perceive danger that is not there.

This also leaves you susceptible to stress and anxiety.

Your brain is going through a period of pruning where neural pathways you don’t use are vanishing and the ones you do use get coated in a substance called myelin so they work faster. All the more reason to build healthy habits so these are the fast neural pathways that get built instead of the unhealthy ones. It will also take you longer to access the thinking brain during adolescence, the part of your brain where executive function and problem solving skills exist and the ability to inhibit or manage emotional responses. Because of this slow maturation in the thinking part of your brain, the emotional system can still take over from the thinking part more easily than for adults. The combination of heightened emotional sensitivity from puberty, and slow developing cortex explains emotional outbursts that you sometimes get swept up in, this is a very normal part of being a teen.

Adolescent brains are also highly sensitive to the release of a neurotransmitter called dopamine. This means adolescents are influenced by experiences that are rewarding and pleasurable and these kind of experiences take priority over other things. This is important when considering risks. As you probably know, adolescents are often accused of making poor choices.

What is important to realize is that adolescents are very capable of assessing risk, what leaves you vulnerable to risky behaviour is the reward system. The reward system can override your thinking and rewards include doing things to impress or get positive feedback from peers. Thus, even if you know something may be risky (e.g. driving without a seatbelt, using substances) you may be tempted to do it anyways if you will get positive feedback from your friends. Hopefully knowing this will help you stay safe!

The changes in your brain continue well into your 20’s so lots of time to build healthy ways of managing stress and anxiety. Overall, adolescents have amazing, dynamic, open, curious, and creative minds that are open to new learning. You will have BIG feelings, good and bad, and these will change and shift so try and notice them and observe them instead of being swept up in them.

Your emotional and behavioural ‘brakes’ are still under development and your thinking brain will not always be in charge, supportive adults can help you manage. Given all the changes, this is an amazing time to build healthy coping with respect to stress and anxiety.

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CHAPTER 2

Your Foundation

I am excited to teach you how to manage and shrink your worry. I know how hard it is to have to deal with worry and how much it can cause distress and interfere with your life. You have been very brave, dealing with your worry as best you can. 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 worry and learn a new way of managing it.

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 some of the practices and strategies with you.

HELPING HAND AND HIGH FIVE: Before we tackle the rest of the workbook and learn about the 3A Toolkit and the plan for managing your stress and worry, I want to know a bit more about your strengths and what helps you tackle challenges like worry. Below is an outline of a hand that I call the helping hand and another hand we will call a high five. On each of the fingers of one hand, I want you to write some of the great things about you that are true even when worry is big. On the fingers of the other hand, write down five things that help you to feel better. You can trace your own hand on a piece of paper if you prefer.

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Here is an example of some of the strengths you might write on your helping hand and some things that might help you feel better for your High Five: HIGH FIVE

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k ab oo

Fa

m

ily

Ti

m

e

Re ad

Nat

Play

Humour

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ure

ty Hones

iou Cur

Pet cuddles

Br

e av

ry

vi ati e r C

ty

sity

HELPING HAND

I want you to think about each of the five strengths you listed on your helping hand. I know you have way more than five strengths but thinking a bit more about these five is a great start.

Also, it is often hard for people with a lot of worry or anxiety to know their own strengths so don’t be surprised if is hard to name your strengths. If you are struggling with this, ask a trusted adult to help you. You can of course name more than five if you want to but please choose at least five to start with.

A strength is more than something you’re good at, it is a quality about you that you consistently demonstrate that 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 that come from lots of research on people (see www.viacharacter.org for more informaiton). 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 Curiousity 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

List each of the five strengths from your helping hand below and consider how each of them helps you, and be as specific as you can. For example, from the helping hand example on the previous page, the strength of curiousity keeps you looking for new learning and keeping an open mind to new experiences. This might have helped you asked questions in class even though you are uncomfortable doing this. Curiousity is a very helpful strength for learning about the 3A Toolkit for shrinking your worry!

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Strength

How this strength helps you….

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! And, if you need the ideas from your high five to feel a bit better, you have those too because learning to shrink your worry is very hard work.

EMOTION Emotions are a type of information processing that include your mind, body, and relationships and 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. 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 notice what emotion is present.

Through being aware of the emotion, 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 focussed on the emotion of worry but of course you will be experiencing many other emotions throughout your day and as you tackle your worry. Another important piece of a strong foundation is growing 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

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POSITIVE EMOTION 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 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, the things you are grateful for can be small and concrete.

Like any new habit or practice, you will have more success with growing positive emotion if you are consistent with doing this every day or as close to this as possible. These practices work well if you can find someone to do it with you.

MINDFUL AWARENESS Mindfulness is 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, body scan and others. 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 swept away by it and being able to tolerate them.

Mindful awareness will be important for all three phases of the 3A Toolkit. Mindfulness is also linked to improved neural integration, positive physical and mental health benefits, and has been shown to be correlated with reduction in anxiety, among other positive results. There are many App’s available also that support a regular mindfulness practice. If you are not ready for long mindfulness practices, even a few minutes can be beneficial. The three minute breathing space is an example of a short practice you can start with (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.

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VALUES AND BELIEFS Another challenge with worry or anxiety is that it can lead to changes in the way you act and interact with the world around you. Sometimes this can be challenging as the worry will get in the way of you doing what you really want to. Consider what is most important to you, what do 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, let’s have a look at the plan for learning to manage and shrink your worry.

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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

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Positive Emotion

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CHAPTER 3

The Plan for Managing Worry The problem that worry causes is that you ‘flip your lid’ as the hand model of your brain shows, or your downstairs brain takes over from your upstairs brain. Our solution then is to put your lid back on and get the upstairs and downstairs brain connected again. The 3A Toolkit is going to help you do this.

There are three sections to the 3A Toolkit: 1. Awareness (Collecting Information) 2. Assign a Label (Organizing Information) 3. Action (Responding to the Information) We will be working towards building you your very own 3A Toolkit so you can shrink your worry down to a size that is easier to manage. Let’s get started by learning more about the three sections of the 3A Toolkit.

3A TOOLKIT: AWARENESS SECTION To solve a problem, you have to collect information about it, this is the main purpose of the Awareness section. This is true for learning to shrink your worry. There are three main categories we need to collect information about and be aware of: 1. Thinking 2. Body activation 3. Relationships and emotion

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 other much less so. We tend to notice the less helpful thoughts more

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than the helpful ones. This is probably for survival reasons and 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”, “this is terrible”. It is kind of like these kind of thoughts are feeding the worry and making it bigger. There is a very important question to ask when you are trying to figure out if something you are thinking is making your worry bigger. Ask yourself: Is the thought helpful?

If the answer is no, then we know we’ll need to work on more helpful thinking in order to shrink the worry. Noticing what thoughts are not helpful and are possibly fueling your worry is very important. The goal is not to stop these thoughts though, but 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 these thoughts it does not work very well. Instead, just notice the thought and that it is not helpful. We will talk more about what to do about the not helpful thoughts in Chapter 4.

BODY ACTIVATION Going back to the example at the beginning of this workbook, worry includes changes in your body as well as 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 to terrible and overwhelming, it gets your attention and overrides your thinking. This is very helpful if you are facing actual physical danger, but with most experiences of anxiety there is not physical danger present.

When you are worried, your nervous system is activated and changes in your body follow.

Some of the body changes include a fast heartrate, 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.

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Here are some examples of what you might notice when you are worried:

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

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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 what your clues are in the form of body changes demonstrate is getting too big and will need some shrinking:

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The important questions to ask yourself about body activation are:

WHERE DO I NOTICE THE FEELING OF WORRY IN MY BODY? WHAT IS MY LEVEL OF ACTIVATION? RELATIONSHIPS 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 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, it is helpful to think about relationships when managing stress and anxiety because these relationships are an important part of your life. 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? Now that you know what to look for in terms of thinking that is not helpful, signs of body activation, and how you are relating to yourself and others, you have completed the Awareness section, and collected important information about your worry. Now we will move on to the Assessment section.

Reflective questions to grow awareness: You will have notice 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 and your subsequent ability to choose the most helpful action strategy once you learn more about these. Here is a summary of those questions:

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AWARENESS CATEGORY

IMPORTANT REFLECTIVE QUESTIONS

Thinking

Is it helpful?

What do I notice about my body?

What is my level of activation?

Body Activation Relationships

Interpersonal (Others)

Is this relationship supportive?

How can I strengthen existing relationships and/or develop new relationships that are supportive?

How are my boundaries?

Intrapersonal (Self)

How am I relating to myself?

How can I be more supportive and compassionate to myself?

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 (Siegel & 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”. You can practice this by 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 sort of feelings and 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.

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I feel _______________________________________________________________________

I feel _______________________________________________________________________

I feel _______________________________________________________________________

I feel _______________________________________________________________________

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 your relate to worry. It’s a bit like you’ll make friends with worry. To get to know your worry a bit better, and make friends with it over time, it can help to assign an image or metaphor to your worry. It might be a monster, a dragon, a kind of person, it is up to you what shape and colour your worry is. Try drawing how you imagine your worry to be in the space below and perhaps give your worry a name.

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By the end of the workbook, once you have built your 3A Toolkit to manage your worry, your worry will seem much smaller and you’ll have a friendlier relationship with it. Let’s draw another version of what your worry will look like after you have finished learning how to shrink it:

I am really looking forward to when you will be friends with the small and much nicer version of your worry!

Let’s get started right away on learning how to shrink your worry into the friendly version. 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. Once you have learned about your brain and body, collected information about your thinking and your body activation in response to stress and anxiety in the Awareness section, organized the information by giving it a label in the Assign a Label section, you are ready to match regulation strategies from the Action section with what you have found.

In the Action section, you will have two buckets of strategies to help you manage and shrink your worry, this will help put your lid back on (from the hand model of the brain). The strategy buckets are: 1. Body Calming 2. Helpful Thinking 3. Relationships

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Helpful Thinking

Body Calming

Helpful Relationships

We fill up these buckets of strategies in the next two chapters on Strategies for Body Calming, Strategies for Helpful Thinking, and Strategies for Relationships. For now, here is the 3A plan for shrinking worry.

THE WORRY SHRINKING PLAN Awareness • Body Activation • Thinking (Is it helpful?)

• Relationships (interpersonal and intrapersonal)

Assign A Label (Name It To Tame It)

Action • Body Calming • Helpful Thinking • Relationships

And when you are finished, you will have your very own 3A Toolkit so you are able to shrink your worry down whenever you need to. On the next page, there is a blank 3A Toolkit that we will fill in as we continue:

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3A TOOLKIT 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 buckets for body calming and helpful thinking, 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 math class at school or a new skill in whatever sport you play, or a new technique in a video game. You are not able to do the new thing well the first time but after lots of practice, you will improve. 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, you are really good at being worried! So, to learn to shrink worry, you will need to practice and it will take some time.

SUMMARY So far in this workbook, we have gone over the 3A Toolkit approach for shrinking worry including the Awareness, Assessment and Action sections. In the next chapters, you will learn strategies to have helpful thinking and to calm the body, filling up your two buckets of strategies so you can shrink your worry. I will teach you how to calm your body first and then have helpful thinking after that. But, if you want to learn about your thinking before learning how to calm your body, you can read the thinking chapter first. Whatever order you learn about the strategies, just know that you will need to be able to use strategies from both the thinking and the body buckets to shrink your worry.

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CHAPTER 4

Strategies for Body Calming Being aware of how your body responds to stress and anxiety 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. 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. You can use a scale of your choice to assess level of activation, in the sample below I have a numeric scale with 0 to 5 representing low to middle levels of activation and 5 to 10 representing high levels of activation.

LEVEL OF ACTIVATION Some information we are going to add to our awareness of how the body is responding to anxiety is level of activation. You can use different scales or descriptions for this, I will use a simple 10 point scale. The exact scale is not as important as the concept that we have different levels of activation which correspond with different physiological events and are managed by varying strategies. For example, if you choose a 10 point scale where 0 represents being asleep and 10 represents a panic attack, from 0 to 5 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.

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

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use the strategies effectively to settle down your body’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, 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 where you end up in terms of your level 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

5

0

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 and they are explained in more detail after that.

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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 using the diaphragm. It can be helpful to go through even breathing, 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.

Figure 8 Breathing Draw a figure 8 on the back of your hand. If you do not want pen on their hand, they can trace the shape with their 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.

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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 and 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 common and 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 also 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 critical for the Awareness and Assessment phases, mindfulness 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.

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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 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 other. Some people like a gentle embrace (butterfly hug) and others prefer much firmer contact (bear hug).

Shaking Engage in rigorous 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 doing this. Many people report very quick results with shaking though, they are able to regulate quite quickly so it really is worth trying this.

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 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, some people find it even makes them feel worse. This doesn’t mean that 32

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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 for 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?

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CHAPTER 5

Strategies for Helpful Thinking 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 let you know it does not work very well to try and stop the not helpful thoughts. Instead, this brings your attention to them even more and tends to grow them even bigger. For example, if I said to you, “I don’t want you to think about cupcakes”, what do 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 Assign A Label 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, these strategies help you to feel safe in your body. One really useful strategy for giving your brain the information that you are safe is orienting (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 messages 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” 34

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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 worry is getting too big.

Sometimes, you will have some not helpful 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 as it is 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” linked to anxiety about a performance, this is clearly not helpful. To generate a helpful thought, thinking “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, to try something like “I can get started” (present focus), “I have the training © 2020, MEG KAPIL, ALL RIGHTS RESERVED

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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 by the amygdala 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 as the main focus of the reptile brain is on our safety.

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 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 focus on what is more helpful.

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 not helpful one, and sometimes it won’t be that closely related, but it will include the building blocks of helpful thinking (present moment focus, focus on capability and what you can influence). Once you have some examples of helpful thoughts, you may want to keep these with you so you can remember them when needed.

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UNHELPFUL THOUGHT

an idiot I’m Not Helpful Thought I can’t do this I’m an idiot I Ican’t do this will never get better I will never get better

HELPFUL THOUGHT (present moment focus, focus on capability, focus on what you can influence) I have worked hard on this presentation and will focus on what I know Helpful Thought (present moment focus, focus on capability, I will get through this and learn from any focus on what you can influence) mistakes that I make I have worked hard on this presentation and will focus on what I know I am managing anxiety better I will getworking throughon this and learnmy from any mistakes make my helpful thinking as I do andthat willI practice this presentation I am working on managing my anxiety better and will practice my helpful thinking as I do this presentation

Not Helpful Thought Helpful Thought (present moment focus, focus on capability, focus on what you can influence)

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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.

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 thought 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 not helpful thoughts 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 or keep going until you feel you have balanced out the thoughts and the helpful ones are ‘heavier’ or ‘stronger’ 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 and each not helpful thought will have a different weight that is unique for you.

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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

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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

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My worry is Pink fluffy unicorns I am learning making up stories dancing on again rainbows 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

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EXAMPLE OF HOW TO LAYER HELPFUL THOUGHTS OVER UNHELPFUL 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 not helpful ones with your own not helpful thoughts. 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 thinking that is not helpful can increase your worry. More than just thoughts, worry will also tell a whole story that can be really convincing. While our minds are very busy and much of our thinking is automatic, we also tend to craft a story or narrative that helps make sense of our current situation and is also shaped by past experiences.

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 will also have a story or narrative that is automatic and helps pull together the different pieces of the experiences 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:

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“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. This 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. Consider the anxiety story above, it 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 it appears credible. For this reason, it can be hard to spot the anxiety story and you may believe this kind of story for no other reason than it matches how you feel.

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 either because you are using reason and thinking to address a system (the limbic system and reptile brain) that are not governed by reason and logic. This can lead to 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 might 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.

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For example, working through the 3 A’s:

AWARENESS

Thinking – notice the anxiety story and other not helpful thinking Body – notice physiological aspects of the anxiety Relationship – Notice how you are relating to yourself

ASSIGN A LABEL

• Name the anxiety • “that is just my anxiety”

ACTION

Thinking – focus on more helpful thinking Body – calm down the body Relationship – offer support and compassion to yourself This is far more effective than continuing with the anxiety story and continuing to fuel the worry.

Now consider recent experiences of anxiety for yourself. What was the story that anxiety crafted about your experience?

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:

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From our example of the person who has anxiety about public speaking, here is a more helpful story: “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” 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.

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.

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CHAPTER 6

Relationship Strategies When we were going over the plan for shrinking worry, 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 a 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 practice 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, and when they 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. Part of how you manage stress and anxiety is learned from the important people around you. Sometimes the important people around you are good at managing stress and other times they have not 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 keep 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. 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).

Learning how to set boundaries will take practice, however, Brene Brown suggests the following:

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Make a mantra: choose a phrase that reminds you to make a choice that is important for 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 Rehearse: Practice saying no, practice with your pet, with yourself, and with others, practice a lot.

Setting boundaries can be really hard, be kind to yourself as you figure this out and know you are worth protecting and taking care of!

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.

How you relate to yourself?

How do your respond when you make a mistake?

What kind of messages do you give 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 vs. 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 help you with this, you can always take a look at how you relate to yourself. If you are someone who is hard on yourself, 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

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statement to yourself like “I’m trying” and that is as kind as you can be to yourself. 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.

Over time, you will be able to practice using the 3A Toolkit approach to managing your worry and will get better at it the more you practice. It is not always easy to use the helpful thinking, body calming, and relationship strategies while you are worried because you have ‘flipped your lid’ and are not able to access your thinking brain at this time. For this reason, a lot of the learning for managing worry is done later when you are once again regulated or calm. I will teach you more about this in the next chapter and you will learn a specific way of rewinding your experience and replaying it with a better ending.

CALM PLACE In addition to self-compassion, part of developing a healthy relationship with yourself includes feeling calm and safe. Worry and anxiety leave you 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 you recall the details.

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CHAPTER 7 The Debrief

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 more calm, 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, when you can socially engage with others, this lets you know you are likely ready to debrief a situation. This is another reason why it can be really helpful to have someone help you with this process.

In a debrief, work through the awareness, assessment, and action areas of the 3A Toolkit.

Consider what you noticed (Awareness), generate a label (Assessment) and 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 & memory strategy. After this, imagine that you rewind the experience back to when you first noticed being worried. Then go through the Awareness, Assessment, 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 a rewrite. 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 manage and 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:

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• Change takes time, be patient.

• Be curious and compassionate about your experience

• Growth and change is supported by cycles of relational 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

REFLECT (using the 3A Toolkit) Awareness

AWARENESS CATEGORY

IMPORTANT REFLECTIVE QUESTIONS

Body Calming

What do I notice about my body?

Thinking

Is it helpful?

Relationships Interpersonal (Others)

Is this relationship supportive?

How can I strengthen existing relationships and/or develop new relationships that are supportive?

How are my boundaries?

Intrapersonal (Self)

How am I relating to myself?

How can I be more supportive and compassionate to myself?

Assign a Label What feeling label will you use to capture your experience (Name It To Tame It)?

Action Using your 3A Toolkit, decide what strategies would work better next time to shrink your worry.

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.

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REPLAY Rewind what happened to the beginning, but this time replay it and imagine or visualize the new ending.

Let’s try out the debrief using the prompts above. Choose a recent experience when you felt anxious and consider the following:

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”

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

• Messages of safety e.g. “This feeling will pass”, “I am safe”, “there are no tigers 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”

RELATIONSHIPS

Body Calming

• Intrapersonal, treating yourself with judgement and criticism e.g. “I’m such an idiot, what is wrong with me”

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

Body Activation

• Interpersonal, e.g. Consider who is able to support you

Relationships Treat yourself with compassion, kindness and support “I am doing my best”

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Once you have figured out what is important in the Awareness, Assessment, 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 feel like you felt more anxious than you wanted to, or want to respond to stress differently. There is a lot of potential for new learning in regards to reflecting on your experience in this way and essentially writing a new ending.

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.

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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 :

BODY CALMING

ACTION How do I shrink the feeling?

HELPFUL THINKING

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3A TOOLKIT COMIC DEBRIEF 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 (Name It to Tame It)

I know I can shrink my worry by :

HELPFUL THINKING

BODY CALMING

ACTION How do I shrink the feeling?

“I am safe” “My worry is making up stories again” “I have practiced a lot and know the presentation material really well” “I will do my best” “People want me to do well” “I will survive even if I make a mistake

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Deep breaths

Butterfly hug

CHAPTER 8

From Avoidance to Approach 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 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 is your next challenge 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.

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EXAMPLE OF A CHALLENGE LADDER: Present in front of a whole class

Really challenging

Present in front of teacher and small group Present to your friends and teacher Present to one or two friends Present to your teacher

Somewhat challenging

A bit challenging

Present to your family members

BLANK CHALLENGE LADDER FOR YOU TO COMPLETE: Really challenging

Somewhat challenging

A bit challenging

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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 (Assessment), 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. 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 target scenario • Approach with curiosity, 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 it helpful?

Body Calming

What do I notice about my body?

What will be my level of activation?

Relationships Interpersonal (Others)

Is this relationship supportive?

How can I strengthen existing relationships and/or develop new relationships that are supportive?

How are my boundaries?

Intrapersonal (Self)

How am I relating to myself?

How can I be more supportive and compassionate to myself?

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Assign a Label What feeling label will you use to capture your experience (Name It To Tame It)?

Action Using your 3A Toolkit, decide what strategies will work to shrink your worry.

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 shrink your anxiety.

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 worry and you are ready for it!

Let’s try out the future success using the prompts above. We will use the example of someone who struggles with public speaking:

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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

RELATIONSHIPS

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

• Intrapersonal, treating yourself with judgement and criticism e.g. “I’m going to mess up, everyone will laugh” • Interpersonal, e.g. Consider who is able to support you

Relationships Treat yourself with compassion, kindness and support “I am doing my best”

Emotion & Memory Notice what I am feeling.

Be curious if my reaction is connected to other experiences.

Emotion Notice the positive, your progress and your successes Memory Calm Place practice before presentation

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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 recursive process of reflecting, providing yourself with feedback using the debrief and future success processes, and continuing to practice strategies and use your 3A Toolkit to manage your stress, worry, and anxiety will help you to manage very effectively over time.

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 avoidance with your challenge ladder and able to systematically visualize future success.

You have made amazing progress so far, let’s look ahead so you can keep this positive change going.

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CHAPTER 9

Planning Ahead 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 top-down, bottom-up, and relationship strategies (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, Assessment, and Action components of the 3A Toolkit, you will develop the capacity to regulate your response to stress and anxiety and work toward integration.

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)

ASSIGN A LABEL

ACTION

(Organizing information)

MINDFULNESS AWARENESS

What are you feeling right now?

Body Activation • What do you notice?

“I feel

• What is your level of body activation?

(Responding to the Information) BODY CALMING ”

• Match the strategy to your level of body activation Helpful Thinking • Messages of safety • Specific helpful thoughts

Thinking • Is this thought helpful?

Relationships • Receive support from others • Treat yourself with kindness and compassion

Relationships • Are there supportive people to help you?

• How do you treat yourself?

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And here is a bit more detail about what goes in the Action section:

3A TOOLKIT AWARENESS

(Collecting information)

ASSIGN A LABEL

(Organizing information)

ACTION

(Responding to the Information)

LEVEL OF ACTIVATION

MESSAGES OF SAFETY

SELF

0-5 • Breathing • Figure 8 breathing • Tummy clench and release • Butterfly hug • Orienting • Grounding

“I can get through this”

• Self-compassion

“This feeling will pass”

• How you relate to difficult experiences • Notice what is already there • Turn towards it • Turn towards yourself with an act of kindness

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

Focus on helpful thoughts: • Capable • Things you can influence • Present moment

“Thank you for trying ot help me Mr. Worry but I am safe”

OTHERS • Relationships • What can you influence?

• Set boundaries and limits if needed?

Or another way to look at the Action section is to look at the buckets of strategies we mentioned earlier with a few strategies added to them:

Body Calming

A bit worried Breathing

Movement

Orienting

Shaking

Butterfly Hug

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A lot worried

Helpful Thinking

Messages of safety

Specific helpful thoughts I am safe, Capable there are no What you tigers here, can I can handle this, worry is influence making right now things up

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Helpful Relationships

Intrapersonal Interpersonal SelfHealthy compassion relationships Treat yourself with kindness Calm place

Boundaries

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)

ASSIGN A LABEL

(Organizing information)

ACTION

(Responding to the Information)

THINKING

HELPFUL THINKING

BODY ACTIVATION

BODY CALMING

RELATIONSHIPS

RELATIONSHIPS

RESILIENCE Learning to manage your responses to stress and anxiety will not happen right away. With practice, you 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. (note: adapted from The Yes Brain by Daniel Siegel and Tina Payne Brysen). 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, fatigue, numb, unmotivated). Anxiety, worry and stress are on the hyperarousal side of the window. Every time you return from hyperarousal back to your window of tolerance (feeling regulated and calm), you widen your window and increase the range within

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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?

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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. 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 I CAN NOT INFLUENCE What other people think What other people do What other people say Past mistakes Weather Height

WHAT I CAN INFLUENCE My response to stress and anxiety Healthy habits Being kind Working hard Asking for help

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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 been learning in the thinking, body calming, and relationship strategy buckets. 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.

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 challenges helps 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.

Finally, your progress will not be in a straight line. Learning to manage and shrink anxiety and worry takes time and a lot of practice. You will be better at this some days than others, there will be ups and downs a long the way. When you hit a bump in the road, remember all the positive steps and progress you have made, remember 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 worry.

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THANK YOU!

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