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Workbook 1

Understanding Panic & Anxiety
Foreword – I had Panic Disorder myself
A 4 Step Recovery Plan
DSM Criteria for Panic Attack & Panic Disorder
Panic Attacks can be part of another disorder
Before we Begin
Two Weeks Towards Freedom
Anxiety is a perfectly normal and necessary part of life.
But what about STRESS ? Isn’t it a bad thing?..
Anxiety symptoms stem from the very helpful ‘Fight or Flight Response’
The Fight or Flight Response Symptoms
Now look at the typical symptoms of a panic attack..
Fight or Flight Sensations are not actually harmful
When Fight or Flight happens for no clear reason we panic
We panic because we make a MISTAKE!
Meet Miss-Interpretation and Mr CATASTROPHE
This ‘mistake’ leads to a cycle of fear, adrenaline, fear, adrenaline
The Panic Cycle
A panic attack CANNOT cause you any ‘actual’ harm
Adrenaline HAS to die down eventually
Misinterpretation and Catastrophisation get us caught in the panic cycle
How we ‘misinterpret’ and ‘CATASTROPHISE’ the symptoms
Common Catastrophic Thoughts
Why do we have REPEATED attacks?!!
It is fear of the panic itself that leads to further attacks..
The ANTICIPATORY ANXIETY Cycle
Everyone becomes caught in the same anxiety trap
You don’t need to get rid of stress to overcome panic
Panic is maintained by Safety Behaviour and Avoidance
The Safety Behaviours Trap
Safety Behaviours play a HUGE part in maintaining panic attacks
An example Safety Behaviour Cycle
The AVOIDANCE trap
You may start to AVOID situations where you think you might panic
What exactly is Agoraphobia?
Commonly Avoided Situations and Places
Why AVOIDANCE makes things worse..
Example ‘AVOIDANCE’ Cycle
Real Life Case Study
The four main CYCLES in PANIC
Summary of Step 1 – Understanding Panic
You are now ready for Workbook 2

Workbook 2

Workbook 2 – Rapid Recovery Skills
The key to TOTAL and ABSOLUTE Recovery
The Problem and The Solution
These skills are not avoidance techniques
Part 1. Change the way you THINK!
Correcting mistaken beliefs ABOUT panic reduces our fear
4 STEPS to changing the way you think about panic
CATCH IT – Identify the unhelpful thoughts
How to find the hidden fearful thoughts
Downward Arrow Technique Questions
Downward Arrow Technique Worksheet
Identifying thoughts using a Panic Sequence Profile
Panic Sequence Profile Example 1
Panic Sequence Profile Example 2
Challenge and Restructure the unhelpful thoughts
Correcting Common Misinterpretations
FALSE ALARM 1. “I’m having a heart attack!”
FALSE ALARM 2. “I’m going to pass out / faint!”
FALSE ALARM 3. “I’m going to stop breathing!”
FALSE ALARM 4. “I’m going crazy – having a nervous breakdown!”
FALSE ALARM 5. “I’m having a stroke!”
FALSE ALARM 6. “I’m going to lose control!”
FALSE ALARM 7. “my vision is blurred.. I’m going blind!”
FALSE ALARM 8. “I’m going to be humiliated!”
FALSE ALARM 9. “I’m going to collapse – I feel so weak!”
FALSE ALARM 10. Waking up in panic (Nocturnal panic attacks)
FALSE ALARM 11. ‘Derealisation’ and ‘Depersonalisation’
FALSE ALARM 12. ‘Obsessional Thoughts’
Obsessional Thoughts Cycle
Obsessional Thoughts – shift to OBSERVER mode.
Keeping a ‘Panic Attack Diary’
Example Panic Attack Diary
Examples of common Catastrophic Thoughts (for Panic Diary)
Examples of common Behavioural Reactions (for Panic Diary)
Recovery Skills Part 2. Acceptance Behaviour Strategies
RESISTANCE and AVOIDANCE maintains the problem
CATCH IT – CHECK IT – CHANGE IT
Don’t ‘TRY’ to RELAX! – just LET GO of any added tension
Why deep breathing exercises can make things worse!
Ride the waves of panic – float through them
Stop ‘Stirring the pond’ – just LET IT BE – DO NOTHING
Stop watching the CLOCK! – It will pass – WAIT – give it TIME.
Ultimate Acceptance # 1. IGNORE the panic – get on with your day
Ultimate Acceptance # 2. EXAGGERATE the symptoms
There is NO NEED to be ‘careful’ with yourself!
Acceptance Behaviour Strategies summary..
Recovery Skills Part 3. Mindfulness Techniques
Lessening your focus on the panic
See the thoughts as JUST thoughts..
See sensations as JUST sensations
Test Pilot mode
Thought Labelling
Question and Answer Technique
How to remember the skills during panic
NORMALISING Statements
NORMALISING statements before or after panic
NORMALISING Statements DURING PANIC
The importance of ‘FLASHCARDS’
An example FLASHCARD
Example FLASHCARD – ‘NORMALISING STATEMENTS’
Cartoon illustrated Visual Flashcard
How practicing your skills on panic attacks develops
No matter what – panic is not harmful
The reason to avoid too many ‘symptom details’
Summary of Step 2 – Rapid Recovery Skills
You are now ready for Workbook 3

Workbook 3

Workbook 3 – Rapid Recovery Practice
Exposure is the KEY to recovery
Graduated Exposure Practice works on 3 levels
3 Types of Graduated Exposure
Learning from Graduated Exposure
EXPOSURE PRACTICE 1 – Overcome Fear of PHYSICAL sensations
Why Interoceptive Exposure practice SO important!
‘Interoceptive’ Exposure Practice POINTERS
‘Interoceptive’ Exposure Practice 1 – Pounding Heart
‘Interoceptive’ Exposure Practice 2 – Dizziness
‘Interoceptive’ Exposure Practice 3 – Choking
‘Interoceptive’ Exposure Practice 4 – Light Headedness
‘Interoceptive’ Exposure Practice 5 – Shaking – Trembling
‘Interoceptive’ Exposure Practice 6 – Shortness of Breath
EXAMPLE Interoceptive Exposure session
If Interoceptive Exposure seems too difficult
Example Interoceptive Exposure Worksheet
Interoceptive Exposure Case Study
EXPOSURE PRACTICE 2 – Lose your fear of EXTERNAL situations
‘REAL LIFE’ Graduated Exposure Practice
Creating your Exposure ‘Fear hierarchy’
An Example ‘Fear hierarchy’ Worksheet
Create a ‘Smaller Steps’ Fear Hierarchy
Example ‘Smaller Steps’ Fear Hierarchy
Planning Real-Life Exposure – S.M.A.R.T. Goals
How long should ‘Real Life’ Exposure last
‘REAL LIFE’ Exposure Practice Essentials
A key moment in Exposure Practice.. learning to ‘WAIT’
Troubleshooting ‘REAL LIFE’ Graduated Exposure Practice
Example – Graduated Exposure Worksheet
Example Exposure SESSION with Cartoons
Exposure Practice FLASHCARD
Exposure – Dropping Safety Behaviours
Example ‘Safety Behaviours’ Cycle – with Cartoons
Examples of common Safety Behaviours
Safety Behaviours fall into 2 categories
DAILY-LIFE ‘Safety Behaviours’ Hierarchy example 1
Safety Behaviours Hierarchy example 2 – ‘Situation Specific’
EXPOSURE PRACTICE 3 – Imaginal Exposure
Imaginal Exposure – How it works
Imaginal Exposure – Illustrated EXAMPLE
Imaginal Exposure – EXAMPLE SCRIPT
‘Behavioural Experiments’
Behavioural Experiments – EXAMPLES
Summary of Step 3 – Practicing Recovery
You are now ready for Workbook 4

Workbook 4

Workbook 4 – Maintaining Recovery
Troubleshooting if progress is slow
A VITAL part of recovery – Dealing with ‘Setbacks’
Dealing with ‘Setbacks’ – Distorted Thoughts and Rational Responses
Dealing with ‘Setbacks’ – Essential Reminders
The benefit of ‘Setbacks’ – moving beyond all doubt
Common ways we maintain anxiety BETWEEN attacks
Dealing with a ‘continuous’ feeling of anxiety
The power of ‘power naps’
Unusual symptoms – Symptom Shifting
A complete LIST of ‘possible’ anxiety symptoms
Anxiety Symptoms: The List
Try to avoid becoming an ‘expert’ on symptoms!
It doesn’t feel like ‘just’ anxiety
Fears about getting better
The strange feeling that you WANT to panic
Are you REALLY ‘accepting’ the feelings
Do less self focussing – ‘Normalise’ your routine
Panic Attacks are not your fault
Dealing with feelings of Depression
More about Clinical Depression
More about Depression
What are the treatment options for Depression?
Problems on awakening from sleep
Problems getting to sleep
What about diet and exercise?
Panic attacks triggered by ‘recreational drugs’
Shouldn’t I be practicing Relaxation Exercises?
Should you take Medication?
Fear of getting Blood Pressure measured..
Dealing with work, friends and family
Professional Help – Going to a Cognitive Therapist
Recommended Reading
Celebrities who have had Panic Attacks

Julie – Panic Disorder

Julie – Panic Disorder – Google Chat Dialogues
DIALOGUE number 1 – ‘Mental Panic’
DIALOGUE number 2 – Anxiety about Recovery
DIALOGUE number 3 – Explaining the ‘Self Talk’ process
DIALOGUE number 4 – Panic after Exposure Practice
DIALOGUE Number 5 – Try not to be overly ‘careful’ with yourself after panic
DIALOGUE number 6 – The impact of panic disorder on the rest of your life
DIALOGUE number 7 – Surprised by sudden ‘setback’
DIALOGUE number 8 – Late night anxiety and sense of isolation and vulnerability
DIALOGUE number 9 – Panic triggered by bad news – then fear of ‘going mad’
DIALOGUE number 10 – Trying desperately to be ‘calm’ means the fear of panic is still there

Denise – Obsessional Thoughts

Denise – Obsessional Thoughts with Panic
4 March to 15 March – Reaching out and assessing the problem
17 March to 30 March – Panic attack in Hairdressers – Overwhelming obsessional thoughts on road trip
8 April to 9 April – Major ‘Setback’ “Am I the ONLY one who is incurable!?”
18 April to 20 April – I can’t accept that the thoughts are JUST anxiety!
24 April to 25 April – “Why is my new attitude not working quicker for me!?”
3 May – Still fearful but we uncovered the reason behind all the anxiety
4 May to 8 May – Uncovering the specific anxiety ‘process’ for Denise
11 May – Trying to break the compulsion for ‘reassurance seeking’
2 June to 3 June – Addressing why she wasn’t sending any worksheets or homework
4 Jun – Finally decides to get serious about the homework and worksheets
7 June to 9 June – ‘mental panic’ and more reassurance seeking
19 June – Thought become so overwhelming I recommend she consider medication
18 July to 29 July – On medication but still no sign of any worksheets or homework
8 Aug to 22 Aug – Finally all the anxiety starts to unravel

Nicole – Panic & Health Anxiety

Nicole – Panic Disorder / Health Anxiety
#1 – Working with the CBT practice after a setback
Panic attack over how many baked potatoes for tea!
Anxiety causing me to doubt my ability to cope at work
Will I ever get back to living a happy carefree life?!
I still find it hard to ‘accept’ that anxiety can make u feel so tense and just rubbish!
Sorry to keep bothering you.. but I’m SURE I’m DYING!
I got that sudden “ohmygod stop everything NOW” sensation, a true feeling of panic
I think I’ve developed an obsession with my iron levels
Nicole’s list of experiences where she was convinced she was in grave danger
Overall, I felt extreme panic but managed to plough through it so I’m pretty pleased.
From panic to pregnant!

Audios

AUDIO number 1 – workbook 1 – Understanding Panic
AUDIO number 2 – Help During a Panic Attack
AUDIO number 3 – If you feel overwhelmed
AUDIO number 4 – help with ‘Mental Panic’
AUDIO number 5 – Dealing with palpitations
AUDIO number 6 – If you wake up in panic
AUDIO number 7 – If you feel anxious and can’t sleep
AUDIO number 8 – How to stay motivated to recover

Emergency Self Talk Scripts

Emergency Self Talk Scripts
When you have panic
When you can’t sleep
Don’t blame your poor body – it’s trying to help!
Dealing with a feeling of ‘Jitteriness’
Fear of leaving the house

Overcome Obsessional Thinking

Overcome Obsessional & Frightening Thoughts
**BEFORE YOU READ ON**
A 3 Step Recovery Plan
Step 1. Understanding OBSESSIONAL Thinking
Different types of obsessional / frightening thinking
The thoughts themselves are not the problem The thoughts are a DECOY..
Obsessional Thoughts Cycle
What makes our thinking become ‘obsessional’
Common catastrophic thoughts that lock us in the cycle of fear
The thoughts are not ‘who you are’
Why might we think thoughts of a disturbing nature?
There goes that song again..
“But these thoughts feel worse than a song stuck in my head!”
“But why am I thinking these thoughts?..”
Your mind does not have a ‘mind of it’s own’
You are NOT the thoughts you are EXPERIENCING the thoughts
This problem is VERY common
When will these thoughts go away!?
What MAINTAINS Obsessional Thinking
Avoidance and Thought Control Strategies
Why Avoidance and Thought Control Strategies maintain the problem
Step 2. Rapid Recovery Skills
Identifying the underlying thought process. What are you REALLY afraid of?
Keeping an ‘Obsessional Thoughts Diary’
Sample Obsessional Thoughts Diary
What you resist.. PERSISTS
The Thought Control PARADOX
Learn to OBSERVE rather than ‘react’ to the thoughts
See the thoughts as Just Thoughts
Describe how you feel as if you were a ‘test pilot’
Question your reactions
Distract yourself if you need to
A useful technique – shift to OBSERVER mode.
How to REMEMBER all this
‘Normalising Statements’
Flashcard for Obsessional Thinking
Step 3. Rapid recovery PRACTICE – Graduated Exposure
Graduated Exposure Practice works on 3 levels
Graduated Exposure – The Basic Procedure
Learning from Graduated Exposure
Exposure Practice – Creating your ‘Fear hierarchy’
Planning your exposure practice
‘Smaller Steps’ Hierarchies
Exposure Experiments – EXAMPLES
Graduated Exposure Worksheet
Graduated Exposure Guidelines
Troubleshooting Graduated Exposure

Mindfulness

An Introduction to Mindfulness
Mindfulness for panic & anxiety isn’t a tool for avoidance or distraction
What is MINDFULNESS ?
Mindfulness seeks to develop and nourish present moment awareness.
Try it now – a ONE MINUTE exercise in Mindfulness
Notice what happens after just one minute of Mindfulness
Why Mindfulness is so important
Thoughts can be with us from morning to night without a break
Sometimes we hardly have time for life at all..
Painful thoughts, feelings and emotions about the past and future can overwhelm us too..
Thoughts and feelings can be so distressing we try to block them out or avoid them
Mindfulness can help to change all this.
Mindfulness alerts you to any negative cycles of thinking or behaviour
Your health and ability to concentrate and tolerate stress will improve
You will find it easier to deal with difficult situations and experiences
Mindfulness in PRACTICE – first lets look at what Mindfulness is NOT
There are two forms of Mindfulness practice
Mindfulness in Everyday Life
Mindfulness in Everyday Life Preliminary Exercise – THE BODY SCAN
The Body Scan Exercise
Mindfulness in Everyday Life Exercise 2. Begin the day MINDFULLY
Mindfulness in Everyday Life Exercise 3. Mindful Walking
Mindfulness in Everyday Life Exercise 4. Mindfulness in Daily Activities
Sitting Mindfulness Practice
What is the ‘goal’ of Sitting Mindfulness
Sitting Mindfulness Practice – It’s like being at the gym
Sitting Mindfulness Practice – Some things that may happen..
Sitting Mindfulness Practice – Some more things that may happen..
What if thoughts get out of control?..
So what CAN we do about thoughts?..
Dealing with Thoughts #1- Using an ANCHOR..
Dealing with Thoughts #2 – See thoughts AS just thoughts
Dealing with Thoughts #3 – Let thoughts BE – just as they are..
Dealing with Thoughts #4 – Labelling the thoughts
What about overwhelming FEELINGS & EMOTIONS?
Emotions become more overwhelming when we extend them into the past or future
Sitting Mindfully With Emotions #1 – Use an anchor
Sitting Mindfully With Emotions #2 – feel the emotion as a bodily sensation
Sitting Mindfully With Emotions #3 – Stay aware in the present moment
Frequently Asked Questions
A 4 Stage Mindfulness Schedule
Mindfulness Practice Schedule
Taking it further – The practise of Self Enquiry
Insight through Self Enquiry
Some interesting facts about Meditation
Famous Meditators
Mindfulness Resources