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Lesson 1 - RELAXATION EXERCISES
Lesson 3 - Replacement Thoughts
Terror struck me out of nowhere. I was heading home from college one weekend, like I had done many times before. But this trip was different. My heart was pounding and my legs shook uncontrollably. As I approached the toll on the Garden State Highway, a million thoughts seemed to go though my head. I actually thought it would explode. For the first time I can remember, I felt like I couldn't make a decision. With my foot still shaking on the accelerator, I lifted it to slow down as I approached the toll both. Could I even get a quarter out of my change holder to throw in the bucket? Should I continue going home or should I turn around and head back to the dorm? What was I going to do? DECISIONS.
I managed to take my shaking foot off the accelerator and apply my left foot to the brake. Now I was at the toll booth, quarter in my sweaty hand. Why was it sweating so? The crazy thought passed through my head that if I threw that quarter into the bucket, no one would know why I was feeling this way. For some reason I believed I must have been drugged. But when? Was it an hour ago before I left school? There was no one I knew who would do such a thing, anyway. And why would this quarter give doctors the answer to what I was feeling now? I must have chosen four or five quarters to discard in the toll bucket. Finally I was committed, now, to continue to the next toll booth. With each toll booth I performed the same ritual of selecting the right quarter to toss. My legs never stopped shaking, my palms seemed ever sweatier. My heart felt like it was in my throat. How could I possibly make it home? I reassured myself with each toll that I was one more toll booth closer to home. Closer to safety, I said to myself. I passed four toll booths that day just like I had done many times before, but this was the first time I had an anxiety attack.
Finally I arrived at the turnpike, but there were two ways I could take to go home. I couldn't decide. Do I take the turnpike? Or should I take Route 1? Never before had I faced such indecision. If I took the turnpike, which would be faster? I would have to grab a ticket and pay a toll. After the extreme anxiety I just had paying tolls, I veered the last second to take Route 1. At each landmark I told myself I was almost home. At every red light I wanted to jump out of the car and scream for help. But surely if I did that, they would lock me up. So instead I stayed filled with terror inside my car. Finally, those decisions of whether to go back to the dorm or which quarter to use for paying tolls was behind me. Legs shaking, trying to stay focused on the merging traffic, I continued to drive. Finally my exit. For some reason my palms were still sweaty, my heart was still racing, and my legs were still shaking. The only difference was that my thoughts weren't racing quite as much. Now all I had to do was stay focused on the road so I could make it to home and safety. As I pulled in the driveway I almost collapsed from fatigue. My strong athletic legs seemed to be mocking me. They shook and buckled as I tried to get out of the car. I tried to run to the front door but my legs only let me walk. And with my brain stressed to a debilitating fog, I could hardly put one foot ahead of the other. Honestly, I wanted to kiss the front steps, but I chose to stagger inside the front door instead.
I don't remember the rest of that day because all I wanted to do was sleep. However, I do remember on Sunday when I had to drive the same road back to school that I was filled with fear. Never before did dread hit me when I had to drive. I had been driving since I was sixteen. This was as natural as walking. But not anymore. Fortunately, I chose to take Route 1: No tolls. Wow, I was able to make a decision. I picked out my four quarters for the Garden State Parkway tolls before leaving home. Yes, with some preplanning I just might be able to do this task. It was still difficult to throw them in the bucket, but with each one tossed I would tell myself I was closer to school. The next few times I had to drive from college to home and back again I had some apprehension, but never again did I experience a full blown anxiety attack on that trip. Looking back, I am so grateful I didn't, because I might have chosen to drop out of college. I would learn later that anxiety can lead to avoidance behaviors, so I felt blessed. I had managed to hold off the avoidance behaviors that time. For years I filed that first attack away in my memory banks. It was not until after graduation that I would have to remember that horrible ride.
The following year I would graduate from college and once again the anxiety monster would come back, this time to stay. My college graduation was stressful for many reasons. The major stress in my life was my father dying of cancer. He would not be able to attend my graduation ceremony. He never did see Marmot College because he was sick from the cancer during my college years. But I never thought how much it would affect me on graduation day. To be honest, I didn't even want to go to the ceremony. But my mother was so proud, she didn't want to miss it. As luck would have it, Dad was in the hospital that weekend, so we all could go to the ceremony. I dreaded it, truthfully.
My brother-in-law and sister and mother went to watch me receive my diploma. On the way back home my brother-in-law pushed the speed limit to get to the hospital. My sister offered words of comfort and support because I was so stressed. With their support I made the more than two-hour ride for the final ride back home. This time I didn't mind my brother-in-law pushing the speed limit. He was doing it to make it to the hospital before visiting hours were over. For me the speed meant I would be in a safe place sooner. We made it just minutes before visiting hours were over. When I showed Dad my diploma, he was so thrilled. The next day he was released and the real work began. I remember Mother and I picking him up from the hospital. He was so frail and weak. And the pain medicines made him irrational. I thought, at least he has an excuse, but why was I so irrational? He was nothing like the images I still carry around of my Father. He was the dad who could do anything. So strong and independent. My Mother wanted me to go away to graduate school. I even had an offer to interview for a job in Washington, DC. Either would have been fine with her as long as I left home. There was a pleading tone in her voice. I didn't understand at the time she wanted to protect me. Later I learned she quit her job around my age to care for her mother who was dying of cancer. A mother's protective love. She desperately wanted to spare me what she knew would be a difficult task. Although she knew she would need help caring for Dad, she wanted to spare me. I decided to compromise. I found a job teaching in a nursery school near home. When I told my dad, I wasn't prepared for his tears. He pleaded with me to stay home and help Mom care for him at home. I declined the job and took on the hardest job of my life instead.
Of course I was young and felt so confident that I could handle any situation. Oh how naive I was at that time. But, I had just completed a four-year degree at the top of my class. How hard could this be? The daily strain of watching a loved one die was one of the hardest and most rewarding things I have ever done. The panic attacks made me feel like I was going to die, pass out or go insane. Why was I tense all the time? Why was I having attacks three to four times a day? This was beyond my comprehension. Confident I was going insane, I didn't even know I had an anxiety disorder. It's comical now when I think how I searched for answers in Freud, Sartre, Kierkegaard, Dostoevsky. Existentialist reading became an obsession with me. There had to be an answer in there somewhere. I wasn't looking hard enough, I told myself. How far off the track to seeking a solution I was by devouring these books, I would only realize years later.
It became easy for me to avoid going out. Since my father needed someone home with him all the time I naturally volunteered. I hid my agoraphobia so well all those months. But when he finally went home to the Lord, I had to tell my mother my well kept secret. I had to tell her I was terrified to go to the mailbox, to eat a full meal, to be alone, and to even sleep.
I remember those days so vividly. The attacks and the avoidance sneaked up on me in stages. One time we took Dad for an hour ride through the countryside. On the way home he was losing blood through his urine. This was very obvious because he had a catheter and I gasped as I saw it filled with dark red blood. He was also slipping in and out of consciousness. I was in complete panic until we made it to the hospital near home. All I could think was that I had to stay sane until we got there. My mother would never have been able to find the way to the hospital. She could drive but needed someone to tell her the way. That someone would have to be me. I knew if I could suppress the anxiety, we would all be safe. It always amazes me how we can push back an attack in crisis. However, the anxiety will come out eventually. Now I was frozen with fear anytime I had to drive. What if I couldn't drive? What if I forgot my name? What if no one would help me?
But that day as we sat in the ER I felt so in control. I use the word "control" because as I look back over this time in my life I learned that a lot of anxiety is a control issue. It is the need to have control or the fear we will lose control. Up until that point I knew if I studied a certain amount of time I could get a passing grade. With more effort I could make the honor roll. Also, much of my younger life was spent studying ballet and ice-skating. Hours were spent in training. With persistence (and tons of falling down on my butt) I knew I would eventually master that new jump I was constantly working on. There was always the sense that a certain amount of effort would make any goal possible. This reality, the reality I based most of my life on now, changed with my father's terminal illness. There was no amount of effort that could stop his dying. So for the first time in my life, I felt completely out of control. (I feel it is important to mention the control issue again. We need to find acceptance with our anxiety disorder. I firmly believed if I had accepted my limitations and circumstances, I would not have suffered as long.) Acceptance does not mean being a quitter or a victim. Actually, acceptance enables you to move forward. When I realized that making my father's last days more comfortable was the goal I felt more in control. This was actually doing something positive.
The dreaded and feared day came as he passed away around 2 A.M. on March 4, 1985. All those fears that I would die or go insane didn't come to pass. This should have proved to me that most of what you fear doesn't happen. So much emotional energy is wasted. Of course, I generally learn the hard way. I was unusually calm at the funeral. Even the 30-minute ride on the turnpike to the grave site passed effortlessly. I didn't realize it at the time but the body has a natural healing response. When the stress becomes overwhelming, your body shuts down. I had that out of body, floating feeling. At this point I was not afraid of that feeling. In the past and again in the near future it would cause me unnecessary anxiety. But, that day it was my friend, not my enemy. It would only be much later that I would learn it would be my friend.
During my father's illness I did manage to do some positive things to relieve the anxiety. It's amazing how naturally you discover some techniques when you're desperate.
We had the cleanest house in town. I did all types of odd jobs around the house. I remember ripping up the basement tile floor because it needed replacing. The work was rewarding and physically draining. Most important, it lessened my anxiety. When I was in the basement working hard physically, I felt free from anxiety. I took the aggression and anger I felt over having this disorder, out on the tile floor. With each tile I ripped up it seemed I was ripping out my anxiety. At this point in my life I couldn't sit still. I had generalized Anxiety Disorder, but I didn't know it.
I remember when I tried to make a tiffany lamp. I cut the glass to fit the templates. I used a grinder to smooth the edges. This project, which I started over 18 years ago to help me relieve stress, never got finished. I never did use the copper foil and solder to put that lamp together. Actually I left it behind when my mother sold the house. It really doesn't matter that it was never finished. That project gave me hours of relief from the anxiety. It served its purpose. For the longest time I berated myself for not finishing a project. I was taught you finish what you start. It was clear I needed to relearn some old concepts.
There were positive moments during that time. For example, I knew all of us needed a holiday. If we couldn't get one physically, then we would take a mental one. Our home had these beautiful bay windows with a view of the Delaware River. Growing up, we would spend our summers at the Jersey Shore. Those were happy, carefree times. One day I got this bright idea to throw a beach party in the living room. We moved Dad to the couch in front of the windows. Mother wore a sun dress and I put on a bathing suit. I spread out beach blankets and made ice tea, (today I would have made decaffeinated but I was still learning). We took a mental escape to the Jersey Shore. When the hospice workers came to check on Father, they said it was a wonderful idea. Some of my parents' friends thought I was a bit silly. But another lesson you learn along the way is not to worry about what people think. If it is legal, moral, or ethnical and it doesn't hurt anyone, why not?
So many hours were spent in total fear. However, I did manage to read Moby Dick to my Father as he lay racked with pain in his bed. These were the things I could do to bring some joy. I don't know if he followed the book but he would comment how wonderful it was that I could read it to him. It brought me some peace and, for some moments, anyway, it helped Dad escape from his chronic pain. If only I knew then that my job was not to cure him of cancer. It was to be there and share time with him. Maybe then the anxiety wouldn't have been so intense. But we tend to be very hard on ourselves, all to often expecting perfection when perfection isn't possible. We want to fix every problem, control every situation, and even know what the future holds for us. This is not possible. The sooner we accept this, the less unnecessary anxiety we will experience.
When my father finally left this earthly plane and all his physical pain behind, it was comforting for me. But now I was stuck in a crazy world of anxiety disorder once again. Filled with fear, I knew I had to tell my mother about my secret.
Fortunately, my mother was very understanding and tried to help. I remember how confused she looked the day I told her. Who wouldn't? Imagine your daughter telling you how afraid she was to drink or eat an entire meal. Why? Well, I tried to rationalize the irrational. I explained to my mother that perhaps the food was poisoned. I was afraid that if I left just a little bit of food on my plate, someone might discover why I became violently ill or died. (Yes, I realize this makes no sense.) She sat with me for hours, both of us taking sips of water until I was able to finish an entire glass. Together, we celebrated this accomplishment. However, in the back of my mind I knew something bad was still going to happen. Somehow, this time the fates passed me by, but they would surely get me one day. If I was sane 20 minutes after I ate or drank something, I felt relief. That was my magical time frame to beat the fates. Sounds a bit superstitious? I was never a superstitious person, but this disorder does some odd things. Control was at the core of my new-found superstition. I was fixated on the number "20". At 20 to or 20 past any hour, I didn't want to do anything. At that point in my life that time of day was the witching hour. Later, I learned it was OCD (Obsessive Compulsive Disorder). At the time it was just another name to add to my growing list of anxiety symptoms. My days were often broken up by these times. I would stress the most at 19 minutes until the hour. By 21 minutes after the hour I seemed to relax a bit. However, the other symptoms of GAD, Anxiety Attacks, and Agoraphobia were still present. Looking back, it seems silly to me now, but at the time it was my "reality." Yet, I still see how I was trying to rationalize my irrational world.
Superstitions have been used for centuries to rationalize irrational events. Maybe this is a genetic throwback. I also spent a lot of time trying to figure out the how and why of this disorder. When I went into the practical, facing it head on, the real progress began. If you are having bizarre thoughts or behaviors, realize it is just a byproduct of the anxiety. It will improve and many of the behaviors will disappear with time.
Eventually, Mother persuaded me to see a counselor. I was terrified to go. Not just because it meant leaving the house. I felt certain I was insane and beyond cure: a hopeless case unlike any other patient. To my relief and surprise, the therapists said I was suffering from separation anxiety. Still, in the back of my mind, I knew I was insane and beyond hope. Just wait until I got the courage to share with the therapists those obsessive scary thoughts that bombarded me daily. Thoughts such as, I will forget my name. Maybe the food I'm eating is drugged or poisoned. The number "20" has mystical power. As I built up confidence with my therapists and myself, I slowly shared my secrets. All too often we hide our disorder. We are afraid we are insane. Then we become afraid we will be judged, rejected or considered a nut case. (It is always a personal decision when and who to share your disorder with, but please do seek help.)
Once I started to venture out in the car, I remember having the constant thought that the person riding with me would just disappear. Who was going to take them I had no idea. Martians maybe? As I said, when you look back it seems funny. But at the time it was my "reality," and a scary one at that. I particularly remember a time when I was venturing out with my mother. We used to drive over two hours to the shore every weekend. One time I had a massive panic attack when we were halfway to the shore. Halfway points are often a source of high anxiety for me. There is this voice inside that says you now made a commitment to this trip. It will take you as long to go back as to go forward. I pulled the car into a gas station. I ran up to a vending machine, all the while fidgeting for coins I could toss into the machine. Yes, I still obsessed about discarding coins. I purchased an ice cold can of Coke. My palms were sweaty, my heart was racing, and I was having a hot flash. Convinced I would spontaneously combust, I ran back to the car. I told my mother in a high pitched frantic voice that we had to go home...NOW. She calmly replied, "OK, but we are halfway to the shore." Sitting behind the wheel, I held the cool, smooth can of pop to my head. It was so calming and soothing. All I could feel was the ice cold can on my hand and forehead. I didn't realize it then, but I had discovered yet more tools to fight my anxiety.
My mother gave me a choice. I had an out. I could go home if I wanted to and not quit. I also had something contextual. I could feel the ice cold can. My awareness now shifted to the can, and the coolness of it. It actually made my hand hurt, it was so cold. Slowly I looked at the steering wheel and the interior of the car. Lastly my eyes gazed on the road which lead to the shore. Frantically, I put the car in drive, stepped on the gas and chose to continue on the road to the shore. Anxiety remained with me, but I was halfway to the shore and with my foot on the gas pedal I was getting beyond that halfway point every second. I couldn't be home that second anyway, and with each mile I was closer to the shore than to home.
You can't imagine how wonderful it felt to finally arrive at the shore. Accomplishing your goal while fighting anxiety at the same time gives you a strong sense of achievement. Now, on long trips, I freeze water before I travel. I can either put it on my head to cool me off, sip the ice cold water or both.
Going back to work was a major trauma as well as triumph for me. After my father passed away I spent the next five months, recuperating from grief and chronic anxiety. Angry that this disorder had stopped me from pursuing a career, I decided to channel that anger. There was a challenge to overcome: I was terrified to travel alone. What does an agoraphobic do? Well, I chose to go to a temporary agency for work. I remember my mother driving to the agency with me. I told the girl who interviewed me that my main concern was transportation. Little did she know the real reason why. She found me an assignment just one mile from home. I was so happy. Also, the commute to work was a straight ride. For some reason, any turns made traveling even harder. Maybe I feared my brain wouldn't remember how to make a left or right turn. How different I was than just a year before when I would travel up to Maine and down to Virginia from Pennsylvania by myself. At that time, traveling, especially traveling alone in my car, was a sanctuary. Now it was a house of horrors. That first day at work I got behind the wheel of the car. With palms sweating and legs shaking, I backed out of the driveway. I drove that mile praying every second. As I pulled into the parking lot, my anxiety level lowered a bit. Progress, even a little bit of progress, was sweet.
In approximately two or three months I grew tired of that assignment. I asked the temporary agency to give me another placement. Of course, I again asked for an assignment close to home. This time I had to make a few turns, but the distance was about the same. Progress was being made but again I became bored with the assignment. This disorder was ruling my career. Ever work choice was made by travel, not job description. My sister was working at a day care center and she told me about an opening. It was a fifteen-minute commute but it only had two turns. Plus, I would have a safe person once at work there: it would be my sister. Could I do it? They wanted to hire someone as a substitute teacher. I loved the idea of teaching children. After anguishing over the commute to the new work place, I decided to take the job. They said they would call me daily if I was needed. That helped me accept the job. I told myself that if they called me on a high anxiety day, I could always say I was ill.
Little did I know they would need me daily. I was given a regular work schedule but thinking I had an "out" helped me accept the position. My first day on my commute to work I had a Seals and Croft tape playing in the car. It took me about four or five songs to get to work that day. From that day on I played the same tape from the same spot going to and from work. Unwittingly I had learned another coping technique. I would not think of the minutes or the miles; I would count the songs. Just two more songs and you are there, I would tell myself. Only one more song. You can do it, I'd urge myself. I must admit that sometimes those songs seemed to drag on for hours instead of minutes, but this method did work.
That was a major breakthrough for me and lead to other work, work that would require even more travel. I felt like a bird that had just learned how to fly. Not only was I teaching nursery school during the week, but on Saturday I was coaching ice skating. On the weekends I often traveled to places with my mother. While on vacation I took my mother 3,000 miles all the way to California. I remember on the way back home I woke her up in Wyoming with a massive panic attack. I said we have to get home...NOW. Home was over 2,000 miles away in Pennsylvania. It was about three or four in the morning. We packed up the car and I drove like the wind until the anxiety faded. We did get to see the sunrise in Wyoming. It was a memorable sight, so I guess the anxiety attack inadvertently produced a positive. It is best if you look for the positive in anxiety situations.
Eventually, ice skating became a full time career. Anxiety attacks and travel challenges still existed, but I wanted to choose my career instead of the anxiety choosing it. There were days when I lied and said my tire went flat. Actually, I couldn't force myself out of the house. The people I worked with didn't know I had anxiety disorder. Fear of judgment stopped me from sharing. After about eleven years I left that career for one in financial services. I remember when the regional vice president of the company interviewed me for the job. I started to cry. It involved travel and public speaking. I told her about my disorder and confessed I wasn't sure I would be able to perform my duties. I would be working with her directly most of the time. To my surprise she was so wonderful. She knew a little about anxiety disorders. We became dear friends and our work relationship was wonderful.
One day my boss told me we would have to fly to Atlanta for a convention. I was terrified. She changed her flight plans to travel with me. She had a close friend who was a psychiatrist. He gave her tips on how to keep me sane on the plane. When she picked me up to go to the airport, she had a safety kit. It was filled with playing cards, drawing paper, pens, word searches, lifesavers and magazines. Right before the plane was about to taxi I almost screamed out loud, "I have to get off...NOW!" As the stewardess stared at us, she tried to reassure everyone in the plane that I would be OK. I chose to put my head between my legs. How silly I must have looked. Once the plane was up in the air and flying level, I started to calm down. I wish I could say the rest of the trip was free from anxiety but I had other situations to face once we landed in Atlanta. We attended lectures in extremely large convention buildings. There were masses of people everywhere. There were rides in taxis, rides over which I had no control. Most of the time I felt spaced out or terrified. One of my most vivid memories was looking for all the exits wherever we went.
But to my amazement I survived the convention. Before I knew it, it was time to board the plane again. And once again that anxiety monster hit. On the plane ride back we were seated next to a man we didn't know. Once again I wanted to flee the plane. My boss calmly explained to him that I was afraid of flying. He asked how he could help to calm me down. He wasn't afraid of flying but he kept my mind occupied by telling me about his days in the Navy, hanging off the side of his ship. He described how he sat in a tiny seat as he attempted to keep his balance as he worked to clean the huge ship. Below him was the menacing ocean. This man understood fear. OK so his fear was more rational than mine, but it still helped me as he empathized with my situation.
As the attacks would start to creep up on me, my boss and our kind seat mate would ask me questions about teaching ice skating. My boss had a psychiatrist friend, and before our flight, the psychiatrist had given her tips on how to divert my attention should I experience anxiety. It worked. People really can be so kind at times. I remember rambling on about how to do a certain jump or spin. Talking about edges and even trying to draw pictures on the paper as I rambled. Both of them had to be so confused by my skating lecture but it did calm me down. They achieved their goal to refocus me. I learned that my mind couldn't focus on the anxiety and another topic at the same time. Finally the anxiety passed. The three of us were so excited that my anxiety passed. The man was sitting in the window seat and he asked if I would like him to put the screen up so I could see the clouds. With enthusiasm I said yes. We even exchanged seats and as I watched those clouds pass by I was filled with bliss. Truthfully, I was still flying when the plane landed. Yes, doing challenging things can be difficult, but the feeling it leaves you with is spectacular. The next few weeks facing challenging things were easier than ever. I was having a major growth spurt.
While working for that company, my mother was in a near fatal accident. Next thing I knew, I was experiencing a setback so severe I had to quit my job. For three straight months she lay in a hospital bed. I went daily to visit her with my aunt. Money started to run out so I needed to find work: any kind of work. I took a job washing cars. Once again I was letting anxiety dictate my work. The car wash was across the street from my apartment so that made it the perfect job at that time. As I began to climb out of the setback, I switched jobs again. The next one was as a waitress, but still it was walking distance from home. During this setback I could only drive when someone was with me.
I had met my husband while I was working for the financial services company. We weren't married then. We didn't even date. He knew I had anxiety disorder when I worked at that company. One day while I was at an outdoor mall, we ran into each other. We exchanged phone numbers and he asked me out. My first response was NO because I was afraid the anxiety disorder would get in the way of a possible relationship. How could I explain my current setback? I explained to him that I was even more anxious than when we first met. He said it would be OK, that we would just go to a movie. Well, I can still remember that first date. We both laugh about it now. In his car he had the newspaper with a few movies picked out. He asked what show I would like to see. The movies were only four miles away and a straight ride from my apartment. Months earlier this would have been easy for me to do, but not now. As we started to drive to the movies, I wanted to jump into the back seat. Not because I was feeling romantic, but because of my feeling of extreme anxiety. I pleaded with him to take me home... NOW. With a confused look on his face, he turned the car around. It is funny how once you start to head back home, you immediately calm down. Well, I must have sounded like someone who couldn't make a decision, because as we approached the apartment, I said we could still go out! There was a restaurant/bar near my apartment. I had never been there so I suggested we go. It was loud and crowded but still I felt safe because I was close to home. They had a live band that played terrible music at high decibels. We ordered some appetizers before the band started playing. Once the music started, we looked at each other and yelled, "Let's leave!"
We compromised that date as well as the next few and chose places that were even closer to my home. In time I felt more confident traveling with him. Eventually we did make it to a movie. Within a few months of dating we were traveling to his family in New York City. That was a two-hour drive one way. Did I ever have anxiety attacks? YES. On those trips I would pack everything but the kitchen sink as a security kit. I would do crossword puzzles, word searches, and I'd write in my journal. At every rest area we pulled the car over. This way I could walk around and relieve some of the anxiety.
One of my favorite things to do was write to my cousin Barbara. I never traveled anywhere without my journal and one day instead of writing in it, I decided to write a letter to my cousin. Barbara, who lives in California, also had agoraphobia and was housebound. I met her for the first time a few years before. She never came out east to visit the family because of her agoraphobia. She told my mother and I about her condition, expecting us to be bewildered. Imagine how surprised she was to find out I also had agoraphobia. To this day she has those letters I wrote her on my NYC trips. We both laugh at those letters now because she could see from my handwriting how the attack was rising, peaking, and finally leveling off. "Barbara," I write in my letter, "I just know I'm going to die this time." But, like every other attack it would peak and then cease. It really helps to talk to someone else who also has this disorder. Barbara has been a great source of hope and help for me over the years.
Why have I come to write the Anxiety Disorder WORKBOOK? After my mother was ill for more than two years, she passed away on April 1998. Then I had a miscarriage on April 1999. This was followed by thyroid cancer in August of 1999. Then the final setback came when we had a still birth November 5, 2000. My husband and I buried our little girl Yvonne Marie a few days later.
My husband's work moved us to NYC the following year. We moved in February and two weeks later he had to leave for job training for three months. It was time for me to have my cancer scans. As if that wasn't stressful enough--a new city, new doctors, and my husband away for months--I was still in setback. My father-in-law was wonderful about taking me to numerous doctor and hospital appointments. He sat for hours and never complained. However, I knew that I was in a severe setback again. I was facing that old anxiety and depression monster again. I started remembering how I first got back out of the house. A few times a week I forced myself to go to the grocery store alone for the exposure therapy. One day I went shopping and bought two plants for the new apartment. I named the plants Victory and Joy to reward my success. I talked to people online and found out there were so many similarities between people with phobias. Often what works for one helps another. My wish is that you too will find survival skills that will help you cope. My life is rewarding, now. I keep the anxiety monster at bay with all the coping skills I've learned along the way. So keep the faith and know that if I can do it, anyone can.
If you are reading this workbook, it is probably because you are experiencing panic and/or anxiety. This workbook is filled with tips to help you gain coping skills to face that anxiety. It is recommended you do the relaxation exercises and keep a journal throughout the entire workbook lessons. Lessons 1 and 2 will teach you relaxation and journal writing. This workbook is put together in a specific order and we recommend you try to stick to the order we have designed. Some lessons you will want to spend a week or more on, and others you may want to spend less time on. We are all at various stages in our recovery and this workbook is meant to be referred to often.
What we want you to be aware of as you start these relaxation exercises is that your body has been in a state of tension for quite some time. Therefore, we need to retrain the muscles to learn to relax. Muscles have memory. Think of an athlete, who through practice and training, produces natural muscle memory from repeating the athletic movements. Examples of muscle memory are: speaking, walking, breathing, driving: the kinds of daily tasks we don't have to think about which muscles we are using when we do these tasks. For example, pick up a pencil. Do you need to think about this action? Most likely you are saying, "Of course not. It comes naturally." But now remember when you were a child learning to write. You probably first learned how to hold a crayon, then use a pencil. And finally the day came when you were allowed to use a pen. Think of these exercises in the same way; as if you are a child learning to relax for the first time. Right now you may be tapping your foot, clenching your teeth or doing a number of other things that you have repeated since you became an anxious person. What we are going to do is retrain you to become a naturally relaxed person. It is most important to HAVE PATIENCE WITH YOURSELF as you practice and focus mainly on the progress. Imagine the rewards of how wonderful it will be to have a natural relaxation response built into your muscle memory. Enjoy the practice and do it as often as possible. We all know the importance of practice. Now focus on the rewards.
WE SUGGEST YOU DO THESE EXERCISES DAILY 2 TO 3 TIMES A DAY IF YOU CAN BECAUSE-
> IT WILL TEACH YOUR BODY A NATURAL RELAXATION RESPONSE AND-
> IT WILL REALLY HELP YOU DURING A PANIC ATTACK
1) START WITH DEEP BREATHS:
You will inhale through your nose and exhale through your mouth. Try to see your tummy rising as you breathe. If at first you feel dizzy or light headed, this is quite normal. We are not used to taking deep, relaxing, cleansing breaths.
COUNT UP TO 10 BREATHS
2) TENSE LEGS AND COUNT TO "3". THEN RELEASE:
You will tense your legs. Hold to the count of three and then release.
You will repeat this step 3 times.
3) TENSE ARMS AND COUNT TO 3, THEN RELEASE:
When you tense your arms you can make a fist if you want to, but undo your fists on release. You will repeat this step 3 times.
4) TENSE STOMACH MUSCLES, COUNT TO 3 AND THEN RELEASE:
To tense your stomach, take a deep breath and pull stomach muscles in and then hold.
You will repeat this step 3 times.
5) TENSE YOUR SHOULDERS, COUNT TO 3 AND THEN RELEASE:
To tense your shoulders, arch your back so your chest sticks out. Generally you will find that there is a lot of tension in your back and shoulders. You will repeat this step 3 times.
6) TENSE YOUR HEAD AND COUNT TO 3 AND THEN RELEASE:
To tense your head you will try to touch your head to your chest. This too is generally an area of much tension so don't pull your head down to your chest. Just go as far as you can and hold, but you will feel tension as you do this step. You will repeat this step 3 times.
7) RAG DOLL:
To do the rag doll stand up slowly and then bend over at your waist and let your arms fall down to your toes. DO NOT TRY TO TOUCH YOUR TOES. You are relaxing your body so think rag doll instead of stretching. Then SLOWLY stand up.
IF YOU FEEL LIGHT HEADED IT IS OK. THIS IS JUST BECAUSE YOU ARE NOT USED TO RELAXING. IN TIME THE FEELING OF DIZZINESS OR LIGHT HEADEDNESS WILL GO AWAY. ALSO, IF YOU ARE DOING THESE EXERCISES AT BEDTIME, SKIP THE RAG DOLL STEP.
IT IS BETTER TO STAY IN BED AND JUST RELAX. ALSO, YOU CAN DO VARIATIONS OF TENSING AND RELEASING MUSCLES WHILE IN THE CAR, AT YOUR DESK, IN A RESTAURANT, MOVIE, ETC. TRY DOING THE LEGS, ARMS, TUMMY AND HEAD. IF YOU CAN DO SHOULDERS, IT WILL REALLY HELP WHEN THAT ANXIETY STARTS TO RISE. YOU CAN PLAY AROUND WITH DIFFERENT MUSCLE GROUPS THAT CAN BE TENSED AND RELEASED LIKE YOUR FEET AND ARMS FOR USE IN PUBLIC PLACES.
1) Do these exercises 3 times a day.
2) Think of ways you can tense and release your muscles in the car, at your desk, the movies, etc. This way you will be prepared in public places to use this tool.
3) Keep track of your progress with the relaxation. Realize that in the beginning relaxation is new to your body and you need to practice that muscle memory. Be patient with yourself and accept that you are retraining your mind and your muscles. That is why keeping track of your relaxation progress will really help.
For example:
> Day one: unable to relax
> Day two: still a bit uncomfortable with relaxing
> Day three: relaxing more on about a scale of 2
> Day four: feeling more comfortable with the shoulder exercise
And so on. Just keep track until you start feeling that natural relaxation repose kick in, but don't stop the exercise; Continue to practice with the goal of creating relaxing muscle memory.
Journal writing will make tremendous changes in your life. First, it will give you a place to vent your feelings. Second, it will let you see how far you have come. It is a record of your journey down the path of recovery. A journal is a place you can keep your private thoughts, become aware of your anxiety, and mark your progress. We will recommend ways to divide up your journal to give you the most benefit.
NEGATIVE THOUGHTS: Keep a log of your negative thoughts for a week. If you like, you can take a small note pad (or a PDA like a Palm or Pocket PC) with you all week long and then transpose them into your journal. In order to fix something you have to first be aware you are doing the behavior. By writing down negative thoughts as they come to you, you will now have the knowledge you need to start changing them.
REPLACING THOUGHTS: Now that you are aware of your negative thoughts, you can start to think of replacement thoughts. We are trying to reprogram ourselves to be more positive and active. Your negative thoughts will probably fall into one of three categories: 1. Things you can act on. 2. Things you cannot control. 3. Things that are just irrational--OCD (Obsessive Compulsive Disorder) thoughts--(those racy scary thoughts). For your journal you will want to place your negative or OCD/scary thoughts on one side and on the other side your new replacement thoughts.
We recommend you do this exercise often. In fact, do this every time you find yourself plagued by a thought that just won't go away or is keeping you from sleeping. Write the thoughts down so you can deal with them later when you are in a calmer frame of mind. If you have a therapist or close friend you may seek assistance with your replacement thoughts.
Ask yourself if you are thinking about a situation that needs attention. If there is anything you can do to take action on it, then make a plan to take action. This is a very effective tool for problem solving. Ask yourself if you are thinking on things that you have no control over and then just give it to a higher power and realize that is it OK not to have control over everything. Just imagine, if you had to control everything- the sun, the moon, the stars, the changing of the seasons, what an awesome task that would be. So, sometimes we just have to accept that there are situations and people we have no control over and have to just let it go. Ask yourself if your thoughts are seeming irrational. Sometimes you will see that in your anxious filled world you are thinking irrational thoughts that cause you anxiety. For example, I have personally had thoughts that people would just disappear while I was riding with them in the car. Fortunately, the thought has long since passed and it wasn't until years later that I realized there was a "rational" connection. (Refer to my opening remarks of my personal experience with anxiety.) My anxiety started when my father was dying of cancer and I used to take him for long drives. But my big fear was that he would die any second while we were in the car. Later I realized that my thoughts of people disappearing in the car was somehow related to this fear of him dying while we were in the car. So in a rational sense he would disappear. Sometimes you will not find a "rational" basis for your fearful thoughts, but the main point here is that the underlying fear was of something I had no control over- the fear of my father dying. We will discuss how to categorize your thoughts in the next two chapters.
In another section of your journal rate your anxiety attacks on a scale of 1 to 10, with 10 representing a full blown panic. When we rate them we begin to have awareness of the pre-anxiety attack symptoms.
Those symptoms might be:
- Sweaty palms
- Racing heart
- Shortness of breath
- Dizziness
- Jelly legs
- Nausea
- Hot flashes
Once we become aware of our body symptoms and learn to rate the panic we will find that a level of 2 or 5 will not keep us from doing what we set out to do. In time you will find that even a level 10 can be handled, but when you see that you only had a level 5 when facing your fear and you know what it feels like to have a 10 you will gain more confidence and awareness. You will also learn what coping skills help you to keep your anxiety from getting to a level 10.
ACCOMPLISHMENTS: In this section you will write down all your accomplishments every time you attempt to face a fear. If you set out to go to the store and have to turn back for home when you are half way there, write it down as an accomplishment, because you always improve when you face the fear.
PROGRESS REPORTS: With the data you have collected on thoughts, and rating your panic and accomplishments, you can now look back and see your progress. This is so important to your recovery because we tend to be too critical of ourselves and fail to see how much we have progressed. Why? Because we want the total cure. Since we have made it to the store or have stayed home alone, this will show us how far we have come in our journey of recovery.
GOAL SETTING is very important. It motivates and pushes us to stretch ourselves. When setting your goals, think of the person you want to become, such as- I want to go back to work or I want to be able to drive alone again. I want to take a long vacation to a far away spot. Also set some goals you see as manageable, too. Such as- I want to go to the grocery store, or if totally housebound I want to get out to the mailbox. But let yourself dream when goal setting. Imagine yourself without anxiety and set goals. You will look at this page every week or month to see how you are progressing towards achieving your goals. You may want to update and change your goals from time to time, too, because often we underestimate ourselves when goal setting. Remember, shoot high; it will stretch you.
REWARDS, (what's in it for me), are great motivators. We cannot stress enough the importance of rewards. The rewards do not have to be elaborate or expensive. You can spend as little as a dollar on yourself to make yourself feel worthy of your accomplishments. You may choose to use award stickers for a job well done, or you might want to begin collecting inexpensive trinkets to track your progress. Of course, there is that wonderful thing known as delayed gratification where you can focus on a major reward like a new sweater, some CD's, or maybe some hot, new electronic equipment -- something you really want-- and reward yourself with it for continued progress. In the beginning, little rewards will give you the instant gratification you need. It can be a candle, nail polish, a magazine or time alone in a hot bath. Watching your favorite TV show. taking a walk, playing a game, or reading a book. Make your list of rewards but allow yourself to dream of a big reward for all your progress. Think how nice it is when people at work get a bonus check for a job well done. Well, this is work and you need to reward yourself! So get creative and use rewards as a motivating factor.
You will find your journal to be an increasingly valuable tool as time goes by. It will become your personal log of progress and when you have a set-back or a day you feel you are getting nowhere, you will have it in writing that you have improved. Also, the journal will give you the confidence to face a situation again. You now have it in writing that you did it before, so you can say, well I know I can do this because I have been here before.
WELCOME TO YOUR NEW LIFE! YES, THERE IS LIFE AFTER ANXIETY, AND IT IS MORE REWARDING THAN YOU CAN IMAGINE!
To begin, set your Journal up into 6 sections as follows:
1) Negative thoughts on one side, Replacement or positive thoughts on the other.
2) Rating your panic attacks.
3) Progress Reports.
4) Rewards.
5) Letters to your anxiety.
6) Notes.
Now begin by carrying around a small note pad or PDA to keep track of all your negative thoughts that you will later put in your journal. You may find that you have a lot of negative thoughts so you may only chose to write in your journal those that you obsess over. Remember, the reason for writing down the negative thoughts for a day is to heighten the awareness so we can begin to change the behavior.
Rate your panic attacks on a scale of 1 to 10. This will really help you see improvement. Write down the activity you were doing when you had the panic attack and what you did to make it a level 2 or 10.
Progress reports: This is a time when you go back and look at activities you are now doing more comfortably. You can write down those activities you would like to do the most such as:
Driving alone
Going back to work
Being home alone
Speaking in front of people
Standing in line
Going grocery shopping
Think of the things you want to work on and rate your anxiety level at this moment. Then go back and re-rate your anxiety level doing these activities.
Rewards: Make a plan for your rewards. This is your place to decide what reward you will give yourself. This section can be set up with stickers for doing an activity and perhaps an inexpensive reward. You may want to use this section to write down the situation you will be facing such as:
Going to the store.
Going to a family function.
Going to a movie.
Being home alone.
Think of what reward you will give yourself for doing each as they come up.
Daily exposure tasks such as picking your children up at school may be rewarded with stickers. Doing a more stress producing situation like going to a family event or giving a speech at work may deserve more of a reward. Have fun with this section but remember to reward and praise yourself.
Letters to your anxiety are wonderful. You can write to it when having an attack. For me, I write to my anxiety like it is a person. I even give this "person" a name. You can try whatever works for you. Pretend you are writing a friend a letter. Tell them what you are doing to keep the anxiety from rising. Explain what you are feeling at the time of the panic. When you make it a person and not an "anxiety", it really helps because you may one day find yourself laughing at your symptoms as you imagine your "friend" receiving the letter.
We are going to work on replacing negative thoughts and those "Oh no this one is really going to make me go insane!" type of thoughts. If we have a thought that just ruminates in our minds, we are having OCD thoughts. The first thing to remember is that it's just a thought and many people have these scary thoughts. We don't act on them; they are just thoughts. We find them unbearable and incomprehensible; they scare us so much that we tend to obsess about them.
Now, like a tape recording in our head, we will learn how to erase this way of thinking and redo the tape we play in our head. We are going to work on making a new positive and rational recording in your head. Realize that you will have some erasing to do, but with time, practice, and repetition you will have peaceful replacement thoughts instead of scary ones. Try to remember a time before you had scary thoughts. Did you ever think something you were ashamed of, like I wish I hadn't (fill in the blank) _________________. The major difference is you had the thought and you let it go instead of obsessing. Thoughts pop in and out of our heads constantly, but it is the obsessing that paralyzes us with fear. That said, let's start learning how to reprogram our thoughts in a more productive and positive way. Now please don't start obsessing that you have caused yourself to have anxiety with your thoughts. Let's just focus on making it all better from this point on because now you know you can fix it.
So how do we start replacement thoughts? One great way is to keep a notebook with you all day long and when the thoughts come, write them down. You will address them later in the day. When you are not in a state of complete panic, look at your thoughts and start thinking how you can now rationalize them and make them more positive. Take those scary thoughts you have written down and think about what would be a suitable replacement thought. If you are having scary thoughts about medical issues, go to the doctor and get a check up. Taking action will give you a sense of control once a doctor has reassured you that there is medically nothing wrong. For example, you may think you have a heart condition or a brain tumor. If that is your scary thought, have the doctor help you with suggestions on how to stop worrying about these conditions so you can go on living each day to the fullest. Often people fear death. That is a common fear. But we have to realize that some things we have no control over. It will just happen. So do we really want to obsess over it and have it rob us of life today? Always ask yourself, "Is this serving me in a positive way? If not, let's rid ourselves of it."
For example, the thought that [I will go insane], (one of my personal favorites), can be replaced with [no one goes crazy from panic disorder], and if I was really going to go crazy it would have happened already.
You can use positive replacement thoughts with OCD, too.
When you just have the urge to do the dishes or wash your hands, tell yourself, I will not die if I wait _______ more minutes to do that activity. It will be fine. Yes, I may feel a bit uncomfortable, but that is just a feeling and it will pass.
You need to make these replacement thoughts believable to you. We know from experience that we will live and survive the panic feeling. We have already survived it many times. Keep reminding yourself that you have had these scary thoughts and feelings before and lived through them. You can do it again.
As a matter of fact, we have been there many times. That is why we are reading this- to change it and make it go away.
One definition of insanity is doing the same thing over and over and expecting a different result, so we will now ask you to try something different. Talk to yourself; reassure yourself that you will survive; tell yourself you have nothing to lose and everything to gain.
So write down your replacement thoughts when you feel you can think rationally. And try to memorize them.
Also, you can memorize certain expressions such as:
IT'S NO BIG DEAL. IT WILL GO AWAY. I HAVE FELT THIS WAY BEFORE. NOTHING BAD WILL HAPPEN.
Try these suggestions or think of some of your own to use when you can't think of constructive replacement thoughts. It will really help.
PRACTICE, PATIENCE, AND SELF-PRAISE WILL HAVE YOU DOING AND FACING THE FEAR BETTER AND DIFFERENTLY.
REMEMBER, WE FUEL THE FEAR WITH OUR NEGATIVE THOUGHTS, SO LETS CHANGE IT AND START PUTTING SOME "WATER" OR REPLACEMENT THOUGHTS ON THAT FIRE.
The best way to start addressing replacement thoughts is to realize the thoughts that need replacing. You may have obsessive or scary thoughts that bombard you, but throughout the day we have tons of negative thoughts. So for one entire day carry a note pad around with you and write down your negative thoughts.
Next, take the thoughts that bother you the most and write them down in your journal. When you are able, go back to these thoughts you wrote down and think about how to replace them with something more positive. Make them believable to you. As time goes by you will see that your replacement thoughts can be replaced with more positive ones.
Lastly, notice the positive changes in your thoughts and how much you grow. We welcome you to a new, better and more positive life. SO START REPROGRAMMING YOUR COMPUTER IN YOUR HEAD.
Commit these replacement thoughts to memory and recite them when you have the negative thoughts.