Overcoming Anxiety
- Understanding Anxiety
- Anxiety prepares us to cope with stressful and dangerous situations. It is a reasonable and sometimes vital response, unless out of proportion.
- Worry, fear and anxiety trigger the release of the hormone adrenaline resulting in bodily changes (e.g. increased breathing rate), psychological changes (e.g. change in thought and feeling) and behavioural changes (i.e. fight or flight).
- People frequently overestimate the threat of a situation and underestimate their ability to cope. When anxious you may experience symptoms such as breathlessness, palpitations, trembling, sweating, dizziness and hot flushes. Your evaluation of the situation may cause you to fight, take flight, freeze or faint.
- The stress response is helpful in the short term to prepare us for physical action but if it becomes chronic or too much, difficulties can ensue.
- In long term stress, bodily changes intensify to become unpleasant. Psychological changes, if sustained, result in worrying and negative thinking. Behavioural changes can magnify and become exhausting, cause physical or mental problems and be detrimental to good health.
- Stress leads to the stress response and distress ensues, resulting in increased stress and this causes the stress response again and a cycle is created.
- Fear is an appraisal of a perceived threatening stimulus; anxiety is the emotional response to the appraisal.
- When anxious you may withdraw from the threatening situation or seek reassurance from others. You may engage in 'What if…?' thinking. Counter this with problem-solving thinking, by asking 'Then what...?' for each 'What if…?' anxious thought.
- You can also use 'What if…?' positive questions (e.g. 'What if I maintain control?') to challenge 'What if…?' negative thinking.
- You need to face your fears – expose yourself to a hierarchy of fears, remaining in the feared situation until your anxiety has subsided and your thinking has changed.
- Decatastrophize your outlook by changing anxiety causing statements such as 'I can't stand it' and 'It's awful' to 'stand it' and 'unpleasant' or 'uncomfortable'.
- Deal with your anxiety while anxious rather than wait until you are comfortable as this may take a long time.
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- When Anxiety Becomes A Problem
- Problems occur when cycles are set up by physical, psychological, behavioural
and social factors. You need to identify the cycles, break the pattern and control
your distress.
- In bodily responses the trigger (an actual or imagined threat) leads to a
physical reaction (e.g. chest pain) and you conclude you are having a heart attack.
This results in alarm and leads to a physical reaction again and starts a cycle.
- In psychological responses, there is an overestimation of danger and an underestimation
of coping ability. This can lead to increased distress and biased thinking. Mood
changes such as hopelessness, misery and irritability can impair your ability
to cope with stress.
- Common thinking biases are: catastrophizing (predicting the very worst);
all-or-nothing thinking (black and white thinking); exaggerating (amplifying the
negative); overgeneralizing (you notice something that is true and make generalizations
about it); discounting the positive; scanning (searching for what you fear, resulting
in needless fear).
- In behavioural responses a person avoids and escapes perceived danger and
seeks reassurance. This prevents them from learning to cope.
- In social responses stressful situations and the indirect or direct behaviour
of others can affect an individual’s stress levels.
- Risk factors make an individual susceptible to anxiety and include: personality
– ‘the worrying type’; family history – fears may be encoded in our genes and
passed on in families; life stresses – stressful events; psychological style –
biased thinking increases the risk of problems; coping skills – unhelpful coping
strategies; social support – lack of sufficient social support.
- Personal and social risk factors lead to the problem of anxiety which is then
kept going by maintaining factors such as ongoing stress.
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- Forms Of Anxiety And Coping With The Problem
- Common diagnoses are:
- phobias – when fears become a problem;
- panic attacks – strong feelings of worry combined with an intense physical reaction;
- generalized anxiety disorder (GAD) – chronic (constantly present) worry;
- obsessive-compulsive disorder (OCD) – compulsion to carry out reassuring mental or physical activity;
- physical problems – e.g. sleeping and gastric problems;
- hypochondriasis – perceived symptoms cause distress;
- burn-out – stress is ignored until it becomes so severe that it interferes with an individual’s functioning;
- post-traumatic stress disorder (PTSD) – a stress reaction to traumatic events.
- Psychological methods and/or medication can be opted for but tranquillizers are unhelpful in the long-term. They may mask the problem and cause dependency and unpleasant side effects. Seek your doctor’s advice before modifying your medication.
- You need to think of the coping strategies you will be introduced to as skills which you need to practice. Consider your experience of anxiety and choose appropriate coping strategies to deal with the problems. Enlist the support of others if you find that helpful. This advice is the first step and you may find you require further therapy.
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- Stress Awareness Training
- You need to monitor your stress and become familiar with what sets it off
and the feelings, thinking and actions associated with the anxiety. You can do
this by keeping a diary. When you feel anxious note the date and time. What was
the event? Rate your distress 1-10 (1 is no distress and 10 is extreme panic).
What caused your anxiety? What was your response to cope with the problem? Re-rate
your distress.
- After two weeks of monitoring your stress levels you should become aware of
what triggers your distress, your bodily feelings and thoughts when distressed,
how your distress levels vary with different situations, what you tend to do when
distressed and what is the best way for you to cope with your distress.
- Make two lists – one of short-term only coping strategies and the other of
long-term coping strategies. You can refer to these when you feel stressed. Try
to incorporate more of the long-term strategies into your set of coping techniques
and attempt to gradually abandon your short-term methods.
- Avoid turning to stimulants such as alcohol, caffeine and nicotine as coping
methods. These have unpleasant effects in the long-term.
- Study your diary to determine what drives your cycles of distress. Is it bodily,
psychological, behavioural or social? See how problems are maintained in 2) When
Anxiety Becomes A Problem.
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- Dealing With Bodily Experiences: Controlling Your Breathing
- Hyperventilation – faster breathing occurs in response to exertion and stress.
In the long-term this can be uncomfortable and cause unpleasant physical symptoms
which trigger more anxiety and more hyperventilation. Another cycle of stress
is set up and can result in a panic attack.
- You can rectify hyperventilation by learning to control your breathing.
- First practice lying down and later sitting or standing. Place one hand on
your stomach and the other on your chest. Breathe in slowly through your nose
until your lungs are full then exhale slowly through your nose. Breathing in and
out counts as one breath – aim to take 8-12 breaths a minute.
- In order to be effective you need to practice this exercise repeatedly.
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- Dealing With Bodily Experiences: Relaxation
- You need to develop relaxation into a skill you can use when you feel muscular
tension due to stress.
- Try to develop a routine and practice your relaxation exercises. Start by
lying down and later you can try sitting or standing. Control your breathing.
- Record your experiences noting the date and time. Rate your distress before
the relaxation exercise, 1-10 (1 is tense and 10 is very relaxed). Which exercise
did you use? Rate your distress afterwards. Make notes of the sort of day it was,
your preoccupations etc.
- Below are three exercises – only move to the next one when you are fully relaxed
after a routine.
- Progressive Muscular Relaxation (PMR) – Breathe slowly and regularly as you
focus on different parts of the body: feet – tense your feet then relax and repeat;
legs – straighten your legs then relax and repeat; abdomen – tense your abdomen
then relax and repeat; back – arc your back then relax and repeat; shoulders/neck
– bring your shoulders up and in and press your head back. Relax and repeat; arms
– stretch out your arms and hands. Relax and repeat; face – tense your face and
bite hard then relax and repeat; whole body – tense your whole body then relax
and repeat.
- After the routine if you still feel tense then repeat it then when you are
relaxed think of something calming to relax your mind. Get up slowly and gently.
- You should practice PMR twice a day until you feel relaxed after the exercise.
- Shortened PMR – You can miss out the tensing and go straight to relaxing the
different muscles. When you have achieved this you can progress to using the routine
at other times and places.
- Simple Relaxation Routine – Identify a word, object or scene you find calming.
Sit comfortably and close your eyes. Be aware of your breathing as you inhale
through your nose. As you exhale, think about your calming mental image. Continue
this until you feel relaxed. You should practice this exercise frequently.
- When you have learned to relax using the three exercises you can start to
use the skills throughout the day. Use something to remind you regularly to relax.
Apply your relaxation skills whenever you need to use them in response to physical
tension.
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- Meditation
- Meditation is achieved in attempting to focus your attention on one thing at a time.
· - You need to meditate regularly to become adept at meditation.
· - Preparing to meditate:
- Choose a sitting position you find comfortable e.g. sitting in a chair, cross-legged on the floor or on your knees with your feet under your bottom.
- Sit, with your back relaxed but straight and let it arch.
- Breathe through your nose with your mouth closed and place your tongue on the roof of your mouth.
- Notice the sensations of contact with the chair or cushion and of where your body touches itself.
- Notice your breathing. Take several deep breaths and feel your abdomen expand and contract with your breathing.
- It is important you maintain a passive, unconcerned attitude about what you are doing during meditation.
- You may wish to start by meditating for only five minutes at a time. Do not force yourself to sit longer than you want to - twenty to thirty minutes once or twice a day is sufficient relaxation.
· - Three basic meditations will be outlined. Choose your favourite and practice it regularly, at least once a day.
- Mantra Meditation
- Select as your mantra a word or syllable e.g. 'one' or 'OM' - it may be a nonsense syllable you find pleasing.
- Prepare to meditate. Sit comfortably and take several deep breaths.
- Chant your mantra silently noticing any sensations in your body with the repetition of your mantra.
- You may wish to chant your mantra aloud. Notice any sensations in your body that are different from when you chant your mantra silently. Do you find chanting your mantra silently or aloud more relaxing?
- Be aware of your chanting and do not let it become mechanical.
- Sitting Meditation
- Sit comfortably
- Focus on the rise and fall of your breath. Concentrate on the sensations of breathing - inhaling and exhaling and your breath filling your lungs.
- When you are distracted from your breathing, gently focus on it again.
- Acknowledge any distracting thoughts by naming the thoughts e.g. worry, planning.
- You need to practice regularly so that you can focus on your breathing more effortlessly and dismiss your thoughts more easily.
- Breath-Counting Meditation
- Sit comfortably and take several deep breaths. Close your eyes or fix them on a spot in front of you. Your eyes may be focused or unfocused.
- Take deep breaths and focus on:
- Inhaling
- The point at which you stop inhaling and start exhaling
- Exhaling
- The pause between the exhale and inhale
- The point at which you start to inhale
- The inhale.
- Continue with this noticing any sensations in your body as you inhale and exhale.
- As you exhale say 'one' and continue counting aloud to the fourth exhale when you say 'four'. Then begin this count again.
- If thoughts intrude, gently return to counting your breathing. Do not worry if you lose count - simply start again.
- If you are distracted by any sensation in your body, focus on it until it recedes then return to counting your breathing.
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- Dealing With Psychological Aspects: Distraction
- A cycle of mounting anxiety is set off by alarming thoughts and images. You
can break this cycle by distracting yourself.
- Physical Exercise – If you keep active you are less likely to be preoccupied
by worrying thoughts.
- Refocusing – Distract yourself by focusing on things around you e.g. listening
to others’ conversations or studying how someone is dressed.
- Mental Exercise – Formulate a phrase, picture or mental exercise that distracts
you e.g. redesign your home, imagine your dream home in detail or recite poetry.
- Develop a set of distraction techniques for different occasions that are suited
to your needs e.g. If you get stressed at interviews then physical distraction
will not be helpful.
- Make two columns – in one write down the situation causing anxiety and in
the other your chosen distraction method.
- Practice your distraction techniques when you are not anxious and try to catch
your anxiety at an early stage.
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- Dealing With Psychological Aspects: Challenging Anxious Thoughts
- Thinking affects your feelings and how you feel affects your thinking. By
altering your thoughts you will feel better.
- You need to recognize the different types of thoughts which include ideas,
expectations and attitudes.
- Worrying thoughts become a difficulty when you cannot get rid off them easily.
- A cycle of mounting anxiety can result if you do not identify and challenge
your worrying thoughts.
- Ask yourself if your worry is irrational and unrealistic. If so then find
a rational statement to replace it.
- There are three steps to challenging worrying thoughts: Identify your worrying
thoughts – Try to catch the thoughts that go through your mind. Monitor your thoughts
when you are anxious each day. Note the date and time and your anxious thought.
Rate it 1-10 (1 is no distress and 10 is most distress) and write down thinking
biases.
- You need to recognize bias in your thinking so that you can rectify your thoughts. Patterns of biased thinking include:
- being personally affected by things;
- taking the blame when you are not at fault;
- mind reading – thinking you know someone’s thoughts when you do not;
- discounting the positive;
- jumping to negative conclusions – interpreting things without evidence;
- emotional reasoning – an over-reliance on feeling to guide judgments;
- catastrophizing – predicting the very worst;
- over-generalizing – you notice something true and make generalizations about it;
- predicting the future;
- labeling – calling yourself names;
- wishful thinking.
- Consider how you can challenge your worrying thought by finding alternative ways of thinking. Think about the reasons both for the worrying thought and against maintaining it. What is the worst case scenario and how could you cope? Try to form a more rational and constructive view of the circumstances. Re-rate your distress.
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- Eye Movement Technique (EMT)
- When you move your eyes rapidly back and forth while vividly imagining a stressful event, negative thoughts can be interrupted and you will gain relief from associated distress.
· - EMT can help you control anxiety that is caused by recent or past events.
- Focus on a stressful thought.
- Rate your level of distress (0-10) while focusing on the stressful thought (0 is complete relaxation and 10 is extreme distress). For EMT to be most effective you need a stress level rating of 5 or 6 (a moderate level of stress). If your initial rating is higher than 6, try reducing your stress level to 5 or 6 by using relaxation techniques. If your initial rating is less than 5, try focusing on the stressful event until you reach a stress level of 5 or 6.
- Once you have reached a stress level of 5 or 6 keep your head still and move your eyes back and forth twenty to twenty-five times between two corners of a room, between your hands placed on each knee or between two sides of a table. You should be able to stop focusing on the stressful event. If you are in a public place you can do EMT moving your eyes from side to side when your eyes are closed - it will look as if you are in deep thought or resting.
- As soon as you have finished rapid eye movement re-rate your distress. EMT significantly diminishes or blocks your ability to focus a thought or image. You should find you get a rating of 4 or less and additional sessions will reduce your level of distress further.
- Repeat steps 1-4 whenever the stressful thought recurs. EMT becomes more effective with repeated exposure. At first you may need to do EMT every ten minutes but soon you will get relief for longer.
- Eventually you should be able to use EMT to gain relief in the moment you have a distressful thought.
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- Imago Graded Exposure
- Make a hierarchy of stressful events and start with the easiest event. Make a list of coping thoughts which reduce your anxiety for that event.
- Relax - if necessary use Controlled Breathing and Relaxation Techniques.
- Imagine you are in the stressful situation - see, hear, taste, touch and smell the situation. Think about your anxiety provoking thoughts and feel your tension mounting.
- Once you are anxious, start relaxing and using coping thoughts while imagining the anxiety-provoking scene for about one minute.
- Rate your anxiety 0-10 (0 is no anxiety and 10 is extremely anxious). If your anxiety is 1 or 0 proceed to step 6 then move to the next situation in your hierarchy. If your anxiety is 2 or more, relax (step 6) and then repeat steps 3 and 4.
- Relax deeply before moving on to the next scene.
- Continue imagining and coping with the scenes until you can cope with the most difficult scene in your hierarchy.
- Practice daily - your first session may be 15-20 minutes but later you may want to extend this to 30 minutes.
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- Dealing With Problem Behaviour – Avoidance: Graded Exposure
- To overcome your fear you need to face it at your own pace. Identify and write
down an accurate description of your fear. Deal with one fear at a time.
- Graded exposure will show you that your fears are not really alarming and
build your confidence. You are trying to learn to master your anxiety rather than
avoiding it. There are three stages:
- Setting targets – Your descriptions of fears such as objects and situations
that cause avoidance and anxiety needs to be arranged in order of difficulty with
the easiest first. These are your targets.
- Grading tasks – Choose a target and plan a series of steps which become progressively
difficult so that you can build on your successes. Each step should be altered
in one aspect at a time to increase the difficulty and allow you to build your
confidence. E.g. If your target is to shop at the supermarket, alone – you could
start by shopping for one item at the local shop with the correct money then with
a credit card then buy several items with a credit card. Next you could try graded
steps at a local store followed by a mini-market and finally at a supermarket.
- Practicing – Repeat each step until your anxiety is no longer there, then
proceed to the next task and reward yourself for your achievements.
- Keep a diary to remind you of your progress. Note the date and task and give
a rating for your anxiety 1-10 (1 is no distress and 10 is most distress). Write
down any other related details.
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- Dealing with Problem Behaviour – : Problem-Solving
- Sometimes there is no time to follow a graded approach – the problem-solving
approach can be useful in these cases. You learn to focus your thinking and find
solutions to your problem instead of panicking. There are six steps in problem-solving:
- Define the Problem – Be specific and try to break the problem into more manageable
tasks. Do one task at a time. Choose your task and specify your goal.
- List Solutions – Try to write down as many ideas, to solve your problem,
as you can.
- Evaluate the Pros and Cons of Each Solution – Consider your solutions and
reject the unsuitable ones. List the remaining solutions in order of usefulness.
- Selecting a Solution and Planning Action - Choose your first solution and
decide how you will put it into action. Rehearse your task and make sure you have
a back-up plan in case your task does not go as planned.
- Do it - Attempt your solution.
- Review the Result of the Solution – If your solution is successful try to
understand why it was so. If your solution is unsuccessful try to comprehend why
it did not work. Praise yourself for having tried and choose your next solution
from your list
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- Assertiveness Training
- The aim of assertive behaviour is to stand up for your legitimate rights and face others without putting yourself or them down.
- Assertiveness training teaches you to increase the number and variety of situations in which you are assertive.
- There are three types of interpersonal behaviour:
- Aggressive - you may be forceful in expressing your opinions, feelings and wants.
- Passive - your opinions, feelings and wants may be withheld completely or partly.
- Opinions, feelings and wants are stated with respect for the rights of others.
- Make sure you are aware of your fundamental rights which include: asking for what you want; saying 'No' without guilt; not being perfect; being ignorant about something; being responsible for your actions; having your own perspective and emotions; being indecisive; choosing whether or not to deal with others' difficulties; expecting privacy, independence and success.
- There are five steps to being assertive:
- What do you want? ;
- What is fair? ;
- Be clear in asking for it;
- Contemplate and be ready for the risks;
- Stay calm
- Practice your arguments in advance and repeat yourself to get the message across. Be prepared to negotiate.
- Think about situations in which you are not assertive and how you could change this and be assertive.
- Write out a detailed description of problem scenes - note when and where the problem occurs; who is involved; what your difficulties are; how you handle it; your fear of what will happen if you are assertive; your goal.
- To deal with a problem situation:
- Consider your rights and wants.
- Unless spontaneous action is required, arrange a mutually convenient time to discuss your problem with the other person.
- Define the problem as specifically as possible.
- Describe your feelings using 'I' messages, to give the other person an understanding of how important the issue is to you.
- Make your request in one or two simple but firm sentences.
- Give positive reinforcement to get what you want e.g. we'll be able to spend more time together. If this will be ineffective try negative reinforcement, describing the alternative way you will look after yourself if your wishes are not met.
- You need to arrive at a workable compromise. Agree to review this after a specified length of time and if you are not both satisfied you can renegotiate.
- Avoid being manipulated - techniques include:
- 'Broken Record' where you choose a concise assertive statement to say over and over to get your message across.
- Delay responding to a challenging statement until you are more prepared.
- Inviting criticism may reveal what is troubling the other person.
- When someone puts you down, acknowledge something you can agree with in their criticism and ignore the rest.
- You can change the focus, from discussing the topic to analyzing the interaction between the two of you.
- In instances where you lack time you could use the short form assertiveness technique. Consider:
- Your thoughts - state the facts as: 'I think…'
- Your feelings - express as 'I' statements: 'I feel…'
- Your wants - specify behaviour change as: 'I want…'
- You need to develop assertive body language. Practice the following basic rules in front of a mirror so that you learn how to apply them to problem situations:
- Maintain eye contact and an erect body posture.
- Speak clearly and firmly.
- Emphasize what you are saying with gestures and facial expressions.
- Learn to listen assertively:
- Make sure you are both ready to listen.
- Listen giving the other person your full attention and ask them to clarify if necessary.
- Let the other person know you have heard what s/he has expressed to you.
- Practice being more assertive in problem situations and consider how it makes you feel.
- Role-playing is a good way to improve your assertiveness in a safe environment before trying it out in real life situations.
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- Competitiveness and Perfectionism
- Most of our problems arise from failing, so learning how to fail without attacking yourself is useful in gaining more control over your mood. Without realizing it, because of the pressure to succeed, we can become competitive and perfectionist people who are daunted by the thought of failure.
- Perfectionism leads to frequent disappointments which results in feeling low.
- Perfectionism can lead to competitiveness when we want to be seen as superior and wish to avoid inferiority.
- To find out in which areas of your life your competitiveness lies ask yourself which areas of your life you would not settle for being average and which concern you regarding what others possess, are achieving or doing.
- A problem with perfectionism is that you evaluate yourself on the products of your activities and disregard your efforts.
- Competitiveness and perfectionism can be directed at our self or at others or we may feel it is expected of us.
- Another problem with competitiveness and perfectionism is that your internal bully often directs frustration and anger toward yourself.
- You may become self-centered from perfectionism and competitiveness if you let your inner bully take control.
- You may experience frustrative anger, anxiety or guilt at not succeeding, because of your negative thinking styles.
- As a result self-attacking or attacking others may increase, leading to you feeling more low.
- You need to consider how you cope with yourself and others when you cannot meet your ideal standards.
- In order to identify your competitiveness and perfectionism think about an occasion when you did not succeed at something. What were your ideals regarding the matter? What were you hoping to achieve and why would that have been good? Were you afraid of inferiority or were you seeking superiority? Were you attempting to attain your own ideals or those dictated by others? Was your objective to gain the favour of others? Are you success orientated or do you try to avoid failure?
- Praise yourself for even your little successes.
- Examine your actions when you fail. Do you attack yourself or others? What do you say in these circumstances? Do you accept failure, if so why? Write these down to make things clearer for yourself. Next explore if you use types of negative thinking e.g. all-or-nothing thinking.
- Learn how to fail so that you need not fear achieving success. Use your rational and compassionate mind to ask yourself firstly how you would advise a friend, then what you wish them to say to you. Can you find alternatives to challenge your negative thoughts and feelings?
- Try to break things up into a manageable size and proceed in steps concentrating on your achievements rather than what you have been unable to do.
- Set realistic standards, become tolerant of others’ mistakes and learn to identify what is ‘good enough’ and accept it.
- Is your life pleasurable or do you not enjoy things? Can you complete one task today? Consider how you might obtain help from others?
- Learn to accept yourself thus gaining confidence and enjoy your success.
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- Dealing With Problem Behaviour: Managing Your Time
- Good time management requires being aware of:
- Your needs and strengths – list these opposite each other.
- Your standard procedure – find out how you use your time at present by keeping
a record of how you spend your time. From the record you will be able to work
out the best way of working. Try to get a balance of work tasks and include breaks.
- Your priorities – identify and rank in order of priority the different areas
of your life. Consider the time you allocate to each and what is realistic and
necessary. Perhaps others are making demands of you that you need to be more assertive
about?
- Setting reasonable goals – keep in mind the important areas of your life when
pursuing goals. Clearly define your goals so you know when you have achieved them.
Some goals will need to be broken down into more manageable steps.
- Once you know the above you can draw up a new more efficient schedule. Use
an organizer and list long-term (within six months), medium-term (within a month)
and short-term (within a week) goals. Set aside time each day to organize. Try
to do a ‘To do’ list of prioritized tasks every day. Plan flexibly and review
every month.
- Delegating – giving over responsibility with authority, to others for appropriate
tasks, is part of good time management.
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- Sleep Management
- The length of sleep necessary varies from person to person.
- Worrying will prevent you from sleeping.
- You need less sleep as you get older.
- Sleep is affected by mood, stress, food, alcohol, exercise and medicines.
- In the long-term, sleeping tablets are not helpful and can be addictive.
- You can manage your sleep problems by changing your behaviour rather than resorting to medication.
- Keep a sleep diary for several nights to ascertain if you have a problem. Note the date and anything that might affect your ability to sleep e.g. your activity before retiring. If you have waking episodes, note your activity to restore sleep. Was it helpful? Next day note the number of hours of sleep you managed to get and rate how alert you feel 1-10 (1 is dull and sleepy and 10 is very alert). Rate your performance that day 1-10 (1 is poor performance and 10 is performed well). If you do have a problem the following suggestions might be helpful:
- Analyze your sleep diary to see if poor sleep is due to stress and is likely to get better as this eases; are there behaviours which result in poor sleep that you could change?; identify helpful and unhelpful ways of coping and avoid the latter.
- Introduce pleasant smells into your sleeping environment to help you relax e.g. potpourri or lavender oil.
- Try to relax an hour or two before you go to bed. Keep your daily stress low and seek counselling or the support of friends if you feel the need. Exercise during the day. Avoid caffeine, nicotine and alcohol and try a warm milk drink before bed. Make sure you are not hungry before retiring as this will keep you awake.
· Ensure you have a quiet bedroom and a comfortable bed and have emptied your bladder before trying to sleep. Use your bed only for sleeping and set an alarm so you wake regularly each day. Avoid naps during the day.
- If you sleepwalk you are advised to discuss this with your doctor as it can be dangerous.
- To cope with disturbing dreams you could try:
- Constructing a positive ending to your disturbing dream and mentally practicing this alternative ending several times before sleeping;
- Practicing beforehand what you might say if the dream occurs;
- Keep water and a towel by your bedside to wash your face with if you wake up sweating - this will help you re-orientate;
- Keep a notepad and pencil within reach so you can record your dreams but beware of reading too much into their interpretation.
- Relaxed Breathing Method:
You could try the following method of relaxed breathing to ease tension and promote sleep:
- Ensure you have some time to yourself and push your worries to one side;
- Sit or lie comfortably and close your eyes with your arms by your side;
- Concentrate on breathing naturally;
- Place your hands on your stomach and breathe in deeply and hold for a few seconds feeling your stomach rise. Breathe out and feel your stomach contract. Repeat and as you breathe out think of a relaxing image or sound. Continue doing this until you feel thoroughly relaxed;
- Count back from 10 then open your eyes and feel how relaxed you are now. Slowly get up and resume normal activities.
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- Dealing With Interpersonal Relationships
- Interpersonal relationships may have caused anxiety or may be preventing you
from recovering – in any event interpersonal relationships will be affected by
anxiety.
- You need to understand your personal relationships and be able to deal with
them effectively.
- Draw interpersonal maps – one for before you developed anxiety and the other for afterwards:
- How your interpersonal relationships are at present;
- How your interpersonal relationships might be now if you did not suffer from your emotional problem;
- How your interpersonal relationships will be in 10 years if you continue to suffer from your emotional problem;
- How you would ideally like your interpersonal relationships to be.
- These will summarize all your relationships and allow you to recognize any changes you may desire.
- List all your important relationships and put yourself in the middle of the
map in a circle.
- Place each person’s name in a circle on the map, around you in the middle
– the closer the relationship to you, the closer the circle to you.
- Join these circle’s to you in the middle with an arrow outward if it is you
mainly giving; an arrow inward if you are mainly receiving; a two-way arrow if
giving and receiving is balanced; a question mark if you are unsure.
- You could also draw maps for how you would ideally like your interpersonal
relationships to be; how your interpersonal relationships might be now without
anxiety; how your interpersonal relationships will be in 10 years if you still
have anxiety.
- Examine these maps noting any differences and set yourself goals to make any desired changes to your relationships.
- For each relationship ask yourself:
- who initiates and terminates contact;
- are you happy with how often you see this person? ;
- who decides what to do or what to talk about? ;
- is there a balance between giving and receiving? ;
- do you want to alter the relationship in anyway?
- Consider questions such as:
- who could I confide in and get advice from? ;
- who would be there for me if I fell ill? ;
- who would lend me money at very short notice?
- Next time you have contact with each person, examine the relationship – participate and observe. Were your predictions correct? – If not, what was different?
- When you have a complete picture of your relationships, think about how you maintain them and in what way you want to change your relationships.
- Two important reasons for making changes are:
- A balanced and supportive social network is necessary for your well-being;
- By altering your relationships but avoiding being controlling, you may increase your sense of control.
- Start by making small changes and monitoring progress. You could also try discussing what you have learned about the relationship with the individual.
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- Removing The Obstacles To Intimacy
- Record and examine closely the things that prevent you from achieving intimacy
with someone. Note your thoughts and reactions when you distance yourself from
a friend or end a relationship and make an analysis e.g. are you overgeneralising?
- Social inadequacy can be an obstacle to intimacy. Apply your assertiveness
skills to your social and work life and observe how socially skilled people handle
situations in particular difficult ones. Rehearse your social behaviours so that
you are comfortable with them.
- Try to grasp your anxious thoughts, examine them closely and if required,
challenge them. What are your anxious thoughts? Is your outlook biased – are there
misjudgments? Consider the evidence to support and discount your thoughts.
- See ‘Overcoming Social Phobia’ in the Forward Counselling Advice Service.
- It is possible to become over-intimate and make ourselves vulnerable to exploitation.
Trust can be given in a series of stages and you can fluctuate as to how much
you trust someone.
- Communication is necessary for all relationships. Record the feelings which
threaten your relationship (e.g. jealousy) and grasp the automatic thoughts. Analyze
them and find alternative ways of dealing with the situation.
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- Conclusion
- Identify future challenges regularly and plan how you will cope.
- Accept that set-backs will occur and learn from them how to cope in the future.
- Ensure you include relaxation into your daily routine and as many pleasurable
activities as possible. Deal with stress before it becomes too much to cope. Be
organized and assertive at home and at work. Avoid tiring yourself by doing too
much. Face your fears in small and safe steps. Praise yourself for your achievements
and be forward planning.
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