COPING WITH ANXIETY

FREE MINI ìHELP YOURSELFî PROGRAM

Dr. John Garlock, LPC, LMFT, LCDC, CEAP

The Family Resource Center

This Program Is Intended As A Self Help

Program And Is Not Intended To Be

A Therapy Program Nor Is It

Intended To Replace

Therapy Services

ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ

COPING WITH ANXIETY

FREE MINI ìHELP YOURSELFî PROGRAM

Dr. John Garlock, LPC, LMFT, LCDC, CEAP

The Family Resource Center

TABLE OF CONTENTS

COPING WITH YOUR ANXIETY: A ìHOW TOî APPROACH

I. What Is Anxiety? AÝ Definition

II. What Causes Anxiety?

III. The Differences Between Anxiety And Anxiety Disorders

IV. How To Evaluate Your Readiness For Change

V. How To Evaluate Your Anxiety Symptoms

VI. Where Do I Go From Here-A How To Approach

VII. Relaxation: A Form Of Anxiety Reduction

VIII. Anxiety Management Handouts

ÝÝÝÝÝÝÝÝÝ

It's Time to Find Your Key to Your Anxiety!

ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Coping With Anxiety

Mini ìHelp Yourselfî Program

LEARNING TO MANAGE YOUR ANXIETY

COMMON REACTIONS AND TIPS FOR COPING

Realizing that something is wrong with how you are feeling and acting and coming to personal terms with yourself and starting to understand and accept that you have an anxiety problem can be an unpleasant experience. Often times, you may experience feelings of anxiety, shame, blame, powerlessness and loss. You may also experience feelings of sadness, guilt, and fear and uncertainty about your coming to terms with the idea that you have anxiety difficulties.ÝÝ Shock and surprise can come when you are informed by a loved one or a coworker or family member or friend that your anxiety related behaviors and patterns are a problem that you must address.Ý Often, you are unable to put a name to what you are experiencing but you certainly know that something is not right.

At times, the case is that you have acted out your anxiety in some way and created a problem for yourself and that you must now clean up the mess that has been created.Ý It is often the situation that you did not intend to have an anxiety problem or troubled interaction but it just seemed to happen.Ý It is also likely that you have had anxiety difficulties in the past and this is not the first situation that you have had to face about your anxiety and how you express it.Ý Now is a good time to work on your anxiety while there is some insight available to you and you are in a positive frame of mind to admit to having a problem and to doing something about it.Ý There is no shame in having a problem.Ý Where the shame comes from is denying the problem or avoiding the problem or ignoring the problem until a much larger problem is created.ÝÝ Anxiety causes you to feel estranged from yourself.Ý If you are the one who decided you have an anxiety problem and there is no crisis that caused you to decide to seek information and skills to manage your anxiety, you are starting at a very positive place in terms of not being in denial about your anxiety and you are not minimizing your anxiety and the impact it has on you and others in your life.Ý I have a lot of respect for anyone who comes to the realization that there is a problem that must be solved and they seek help on their own.Ý Anxiety recognition is the beginning step!

If you have experienced anxiety, you are responsible for your anxiety and actions and what happened even though you may not now believe that you are the source of the problem.Ý Having a problem of some sort is not a ìbadî thing but doing nothing about it makes you vulnerable for future significant life losses that you do not want to experience.Ý Admitting that you have a problem is the first step to recovery from the problem.Ý The first step of any 12 step self help recovery program is the following:î I admitted that I was powerless over my anxiety and that my life has become unmanageableî.Ý You must admit to having an anxiety problem and also admit that your life is becoming more and more unmanageable due to your powerlessness over your anxiety difficulties.Ý Since one hallmark of anxiety is your lack of control over yourself, you must admit that you are powerless so that you can acquire the tools that you need in order to claim power over your anxiety.Ý Your anxiety serves a purpose to you in your life and you must come to understand what that purpose is if you are to begin a recovery process.Ý

This is the point in time where so many people get scared just reading about the information contained in this introduction up to this point.Ý It is important to note that your anxiety, whatever the cause might be, is creating significant problems for you in your life which will result in significant losses for you if it remains unaddressed.Ý

If you are getting scared at this point about this information, you may not yet be ready to work constructively on your anxiety.Ý It may just be that you will have to experience further anxiety before you can come to believe that you have a problem that requires intervention.Ý If you do believe that you have an anxiety problem and that you need additional skills and tools to deal with your anxiety effectively than this mini self help program is for you.Ý I have spent over 15 years treating anxiety problems and disorders and I have helped many people to learn how to manage and resolve their anxiety difficulties.Ý And, I believe that this mini program that I have written for you can help you start on the road to anxiety recovery.Ý Please note that recovery from any problem is not an event but rather a process which is a life long one.Ý Why not make a commitment to yourself to stop the insanity today and start a program of personal anxiety management today?Ý Just do it!Ý Visit our practice web site to get further information at:Ý www.helptochange.com and also read our practice newsletter at www.frnewsletter.com for additional information and tools.

ÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Coping with anxiety is a healthy process for all involved.ÝÝ The losses that come from having anxiety problems often accompanied byÝ feelings of loss: loss of identity, security, pride, ability to trust and sense of security. The stages people go through in dealing with their anxiety problem are very typical for anyone who has experienced a loss situation.ÝÝ Please remember that loss effects us all differently and that the grief process you may be having is normal and is supposed to be happening.Ý At times, we will experience grief about not getting something we really wantedÝ or losing something important due to our anxiety problems.Ý Anxiety often leads to grief reactions if we can get past our defensiveness to admit that we have or will have losses which we brought onto ourselves which only we can cope with.Ý Repairing the losses is a positive task in that we become honest about ourselves, our problems and our lack of skills which then can lead to positive change and growth.Ý Blaming others does slow down the healing process and is very common when people are attempting to over come anxiety difficulties.Ý What you feel you can heal!Ý

Since anxiety is a normal emotion that we all have, it is important to understand that it is an important emotion in our emotional makeup and that it has a place in our lives.Ý When it becomes a problem, then we must intervene and modify it.

One of the first things that you must do to start a program of anxiety management is to understand what anxiety is and what it is for you and what it means to you.Ý

You will then need to understand the various forms that anxiety problems can take and what you can do about them.Ý Then, you will need to evaluate your anxiety using our assessment tool to learn more about your anxiety.Ý The anxiety assessment tool comes later in this program and I encourage you to take it so that you can learn more about yourself.Ý You can even have others complete it while rating you on the items as well.

Finally, working on your anxiety can help you to understand it and manage it as needed.Ý However, there are many forms of anxiety that require professional intervention that this program will identify but will not be able to provide self help intervention to resolve.Ý Some forms of anxiety are so severe as to require medical and other professional interventions.Ý These will be identified for you so that you will know what your options are and what you can do to resolve your issues no matter that form they might take.

Who Has Anxiety? Not Me, Of Course!

Mini Self Help Program

Coping With Anxiety

What Is Anxiety?

The word anxiety comes from the Latin word anxius, meaning a condition of agitation and distress. The term has been in use since the 1500s.Ý Anxiety is one of the most misunderstood aspects of our daily living.Ý It is often misdiagnosed and mistreated and can be overlooked for years in a personís life.

You can better understand the nature of anxiety by looking both at what it is and what it and is not. For example, anxiety can be distinguished from fear in several ways. When you are afraid, your fear is usually directed toward some concrete, external object or situation. When you experience anxiety, on the other hand, you often canít specify what it is youíre anxious about. The focus of anxiety is more internal to you than external or outside of you. It seems to be a response to a vague, distant, or even unrecognized danger. You might be anxious about ìlosing controlî of yourself or some situation. Or you might feel a vague anxiety about ìsomething bad happening.î

Ý Anxiety affects your whole being. It is a physiological, behavioral, and psychological reaction all at once. On a physiological level, anxiety may include bodily reactions such as rapid heartbeat, muscle tension, queasiness, dry mouth, or sweating. On a behavioral level, it can sabotage your ability to act, express yourself, or deal with certain everyday situations.

Psychologically, anxiety is a subjective state of apprehension and uneasiness. In its most extreme form, it can cause you to feel detached from yourself and even fearful of dying or going crazy.

The fact that anxiety can affect you on a physiological, behavioral, and psychological level has important implications for your attempts to recover. A complete program of recovery from an anxiety disorder must intervene at all three levels to

ÝÝ 1.ÝÝÝ Reduce physiological reactivity
ÝÝ 2.ÝÝÝ Eliminate avoidance behavior

3. ÝChange your own interpretations (or ìself-talkî) to life events which perpetuate a state ofÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ ap‚prehension and fear and worry in your life

Anxiety can appear in different forms and at different levels of intensity. It can range in severity from a mere twinge of uneasiness to a full-blown panic attack marked by heart palpitations, disorientation, and terror. Anxiety that is not connected with any particular situation, that comes ìout of the blue,î is called free-floating anxiety or, in more severe instances, a spontaneous panic attack. The difference between an episode of free-floating anxiety and a spontaneous panic attack can be defined by whether you ex‚perience four or more of the following symptoms at the same time (the occurrence of four or moreÝ of the following symptoms defines a panic attack):

ïÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Shortness of breath

ïÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Heart palpitations (rapid or irregular heartbeat)

ïÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Trembling or shaking

ïÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Sweating

ïÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Choking

ïÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Nausea or abdominal distress

ïÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Numbness

ïÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Dizziness or unsteadiness

ïÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Feeling of detachment or being out of touch with yourself

ïÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Hot flashes or chills

ïÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Fear of dying

ïÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Fear of going crazy or out of control

If your anxiety arises only in response to a specific situation, it is called situational anxiety or phobic anxiety. Situational anxiety is different from everyday fear in that it tends to be out of proportion or unrealistic. If you have a disproportionate apprehension about driving on freeways, going to the doctor, or confronting your spouse, this may qualify as situational anxiety. Situational anxiety becomes phobic when you actually start to avoid the situation: if you give up driving on freeways, going to doctors, or confront‚ing your spouse altogether. In other words, phobic anxiety is situational anxiety that includes persistent avoidance of the situation.

Often anxiety can be brought on merely by thinking about a particular situation. When you feel distressed about what might happen when or if you have to face one of your phobic situations, you are experiencing what is called anticipatory anxiety. In its milder forms, anticipatory anxiety is indistinguishable from ordinary ìworrying.î But sometimes anticipatory anxiety becomes intense enough to be called anticipatory panic.

There is an important difference between spontaneous anxiety (or panic) and an‚ticipatory anxiety (or panic). Spontaneous anxiety tends to come out of the blue, peaks to a high level very rapidly, and then subsides gradually. The peak is usually reached within five minutes, followed by a gradual tapering-off period of an hour or more. Anticipatory anxiety, on the other hand, tends to build up more gradually in response to encounteringóor simply thinking aboutóa threatening situation, and then usually falls off quickly. You may ìworry yourself into a frenzyî about something for an hour or more and then let go of the worry as you find something else to occupy your mind.

KNOWN CAUSES OF ANXIETY DISORDERS

I.ÝÝÝÝÝÝÝ Long- term, Predisposing Causes

A. Heredity

B. Childhood Circumstances

1.Ý Your Parents Communicate an Overly Cautious View of the World

2.Ý Your Parents Are Overly Critical and Set Excessively High Standards

3.Ý Emotional Insecurity and Dependence

4.Ý Your Parents Suppress Your Self-Assertiveness

C. Cumulative Stress Over Time

II.ÝÝÝ Biological CausesÝÝÝÝÝÝÝÝÝÝÝ

A. Physiology of Panic

B. Panic Attacks and the Noradrenergic Hypothesis

C. Generalized Anxiety and the GABA/Benzodiazepine Hypothesis

D. Obsessive-Compulsive Disorder and the Serotonin Hypothesis

D. Medical Conditions That Can Cause Panic Attacks or Anxiety

III.ÝÝ Short-Term, Triggering Causes

A. Stressors That Precipitate Panic Attacks

1.Ý Significant Personal Loss

2.Ý Significant Life Change

3.Ý Stimulants and Recreational Drugs

B. Conditioning and the Origin of Phobias

C. Trauma, Simple Phobias, and Post-Traumatic Stress Disorder

IV.ÝÝ Maintaining Causes

A. Avoidance of phobic Situations

B. Anxious Self-Talk

C. Mistaken Beliefs

D. Withheld Feelings

E.Ý Lack of Assertiveness

F.Ý Lack of Self-Nurturing Skills

G. Muscle Tension

H. Stimulants and Other Dietary Factors

I.ÝÝ High-Stress Lifestyle

J.Ý Lack of Meaning or Sense of Purpose

You will note that there are numerous contributors to anxiety which currently are known. You may not ever know the exact cause of your anxiety but it is very likely that there are several causes of your anxiety difficulties.

Anxiety Versus Anxiety Disorders: The Differences And Similarities

Anxiety is an inevitable part of life in contemporary society. Itís important to realize that there are many situations that come up in everyday life in which it is appropriate and reasonable to react with some anxiety. If you didnít feel any anxiety in response to everyday challenges involving potential loss or failure, something would be wrong. This workbook can be of use to anyone experiencing normal, ordinary anxiety reactions (everyone, in other words). It is also intended for those of you who are dealing with specific anxiety disorders. Incorporating exercise, breathing skills, relaxation, and good nutritional habits into your daily lifeóas well as paying attention to self-talk, mistaken beliefs, feelings, assertiveness, and self-esteemócan all contribute to making your life more balanced and less anxious, regardless of the nature and extent of the anxiety you happen to be dealing with.

Anxiety disorders are distinguished from everyday, normal anxiety in that they involve anxiety that 1) is more intense (for example, panic attacks), 2) lasts longer (anxiety that may persist for months instead of going away after a stressful situation has passed), or 3) leads to phobias that interfere with your life.

The criteria for diagnosing specific anxiety disorders have been established by the Ameri‚can Psychiatric Association and are listed in a well-known diagnostic manual used by mental health professionals. This manual is called DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders). On the other hand, donít be unduly concerned if your reaction is perfectly described by one of the diagnostic categories. Approximately eight percent of the people in the United States would find themselves in your company.

Here are the various anxiety disorders defined by DSM-III-R:

ïÝÝÝÝÝÝÝÝÝ Panic Disorder

ïÝÝÝÝÝÝÝÝÝ Agoraphobia

ïÝÝÝÝÝÝÝÝÝ Social Phobia

ïÝÝÝÝÝÝÝÝÝ Simple Phobia

ïÝÝÝÝÝÝÝÝÝ Generalized Anxiety Disorder

ïÝÝÝÝÝÝÝÝÝ Obsessive Compulsive Disorder

ïÝÝÝÝÝÝÝÝÝ Post-Traumatic Stress Disorder

Mini Self Help Program

Coping With Anxiety

Panic Disorder (This requires professional treatment services)

Panic disorder is characterized by sudden episodes of acute apprehension or intense fear that occur ìout of the blueî without any apparent cause. Intense panic usually lasts no more than a few minutes, but, in rare instances, can return in ìwavesî for a period of up to two hours. During the panic itself, any of the following symptoms can occur:

ïÝÝÝÝÝÝÝÝÝÝÝ Shortness of breath or a feeling of being smothered

ïÝÝÝÝÝÝÝÝÝÝÝ Heart palpitations

ïÝÝÝÝÝÝÝÝÝÝÝ Dizziness, unsteadiness, or faintness

ïÝÝÝÝÝÝÝÝÝÝÝ Trembling or shaking

ïÝÝÝÝÝÝÝÝÝÝÝ Choking

ïÝÝÝÝÝÝÝÝÝÝÝ Sweating

ïÝÝÝÝÝÝÝÝÝÝÝ Nausea or abdominal distress

ïÝÝÝÝÝÝÝÝÝÝÝ Feeling of unrealityóas if youíre ìnot all thereî (depersonalization)

ïÝÝÝÝÝÝÝÝÝÝÝ Numbness or tingling in hands and feet

ïÝÝÝÝÝÝÝÝÝÝÝ Hot and cold flashes

ïÝÝÝÝÝÝÝÝÝÝÝ Chest pain or discomfort

ïÝÝÝÝÝÝÝÝÝÝÝ Fears of going crazy or losing control

At least four of these symptoms are present in a full-blown panic attack, while having two or three of them is referred to as a limited symptom attack.

Your symptoms would be diagnosed by a counseling professional as panic disorder if you either: 1) have had four panic attacks in a one-month period or 2) have had one panic attack followed by a month of continual worry about having another. Itís important to recognize that panic disorder, by itself, does not involve any phobias. The panic doesnít occur because you are thinking about, approaching, or actually entering a phobic situation. Instead, it occurs spontaneously and unexpectedly for no apparent reason.

Agoraphobia (This Requires Professional Treatment Services)

Of all the anxiety disorders, agoraphobia is the most prevalent. It is estimated that one in twenty, or about five percent of the general population, suffers from varying degrees of agoraphobia. The only disorder that affects a greater number of people in the United States is alcoholism.

The word agoraphobia means fear of open spaces; however, the essence of agoraphobia is a fear of panic attacks. If you suffer from agoraphobia, you are afraid of being in situations from which escape might be difficultóor in which help might be unavail‚ableóif you suddenly had a panic attack. You may avoid grocery stores or freeways, for example, not so much because of their inherent characteristics, but because these are situations from which escape might be difficult or embarrassing in the event of panic. Fear of embarrassment plays a key role. Most agoraphobics fear not only having panic attacks but what other people will think should they be seen having a panic attack.

It is common for the agoraphobic to avoid a variety of situations. Some of the more common ones include

ïÝÝÝÝÝÝÝÝÝ Crowded public places such as grocery stores, department stores, restaurants

ïÝÝÝÝÝÝÝÝÝ Enclosed or confined places such as tunnels, bridges, or the hairdresserís chair

ïÝÝÝÝÝÝÝÝÝ Public transportation such as trains, buses, subways, planes

ïÝÝÝÝÝÝÝÝÝ Being at home alone

Perhaps the most common feature of agoraphobia is anxiety about being far away from home or far from a ìsafe personî (usually your spouse, partner, a parent, or anyone to whom you have a primary attachment). You may completely avoid driving alone or may be afraid of driving alone beyond a certain short distance from home. In more severe cases, you might be able to walk alone only a few yards from home or you might be housebound altogether. I know of one agoraphobic who was unable to leave her home without being accompanied.

Social Phobia (This Requires Professional Treatment Services)

Social phobia is one of the more common anxiety disorders. It involves fear of embarrassment or humiliation in situations where you are exposed to the scrutiny of others or must perform. This fear is much stronger than the normal anxiety most non-phobic people experience in social or performance situations. Usually itís so strong that it causes you to avoid the situation altogether.

The most common social phobia is fear of public speaking. In fact, this is the most common of all phobias and affects performers, speakers, people whose jobs require them to make presentations, and students who have to speak before their class. Public speaking phobia affects a large percentage of the population and is equally prevalent among men and women.

Other common social phobias include:

ïÝÝÝÝÝÝÝÝÝ Fear of blushing in public

ïÝÝÝÝÝÝÝÝÝ Fear of choking on or spilling food while eating in public

ïÝÝÝÝÝÝÝÝÝ Fear of being watched at work

ïÝÝÝÝÝÝÝÝÝ Fear of using public toilets

ïÝÝÝÝÝÝÝÝÝ Fear of writing or signing documents in the presence of others

ïÝÝÝÝÝÝÝÝÝ Fear of crowds

ïÝÝÝÝÝÝÝÝÝ Fear of taking examinations

Sometimes social phobia is less specific and involves a generalized fear of any social or group situation where you feel that you might be watched or evaluated.

While social phobias are common, you would be given a formal diagnosis of social phobia only if your avoidance interferes with work, social activities, or important relationships. As with agoraphobia, panic attacks can accompany social phobia, although your panic is related more to being embarrassed or humiliated than to being confined or trapped. Also the panic arises only in connection with a specific type of social situation.

Social phobias tend to develop earlier than agoraphobia and can begin in late childhood or adolescence. They often develop in shy children around the time they are faced with increased peer pressure at school. Typically these phobias persist (without treatment) through adolescence and young adulthood, but have a tendency to decrease in severity later in life. Recent studies suggest that social phobia is somewhat more prevalent among men than women.

You can recover from social phobias by gradually exposing yourself to the situation you have been avoiding, first in imagination and then in real life.Ý There is medication specifically designed for social phobia which is called Paxil.Ý A counseling professional can help you to explore this treatment option. You can contact Dr. Garlock by emailing him at jagvw@earthlink.net for more information.

SIMPLE PHOBIA (This Requires Professional Treatment Services)

Simple phobia typically involves a strong fear and avoidance of one particular type of object or situation. There are no panic attacks or fear of panic attacks, as in agora‚phobia, and there is no fear of humiliation or embarrassment in social situations, as in social phobia. The fear and avoidance are strong enough, though, to interfere with your normal routines, work, or relationships. Even though you recognize its irrationalities, a simple phobia can cause you significant distress.

Among the most common simple phobias are the following:

Animal Phobias: These can include fear and avoidance of snakes, bats, rats, spiders, bees,Ý dogs, and other creatures. Often these phobias begin in childhood, where they are considered as normal fears. Only when they persist into adulthood and disrupt your life or cause significant distress do they come to be classified as simple phobias.

Acrophobia (fear of heights): With acrophobia, you tend to be afraid of high floors of buildings or of finding yourself atop mountains, hills, or high-level bridges. In such situations you may experience 1) vertigo (dizziness) or 2) an urge to jump, usually experienced as some external force drawing you to the edge.

Elevator Phobia: This phobia may involve a fear that the cables will break and the elevator will crash, or a fear that the elevator will get stuck and you will be trapped inside. You