Reduction of Worries and Stress Module

Chronic worrying and stress is debilitating –many people complain that they have worried all their lives. In this module we will examine a variety of techniques that are helpful in reducing the amount of worry and its negative impact.

Our Goal in this Module:

teach a variety of techniques that are helpful in reducing the amount of worry and its negative impact.

teach methods you might like to use help you relax and to improve concentration. This includes three different methods.

Question:

What do you think when you feel anxious? When you feel worried? Do you ever have visual images or scenarios in your mind when you are anxious? Are you predicting something bad will happen?

Example:

Shawn feels really anxious on his way to the party.

He thinks that he will look like a fool because at the party he won’t have anything to say and would fumble for words. He imagines that people will talk bad about him.

Exercise: 1

Write down examples of worries that you have about the coming week or month. Sometimes when there is a problem, people confuse a feeling such as anxiety or nervousness with the actual worry.  For example, the worry might be “I will not pass the test, and the feeling in response to that worry is one of the nervousness or tension.

Sometimes people believe that writing down their concerns will make them more worried and the thoughts stronger. Actually the opposite is true. You will see that writing down your thoughts will help you get more distance from them.

Self-monitoring of worries

Write down the date and time  of each of your worries, noting the situation that give rise to each. Then note the emotion or feeling (anxious, sad, helpless, self–conscious), and the specific content of your worry (I will get into an argument or I won’t know what to do).

Exercise: 1

Date/Time Describe Situation Emotion or Feeling Specific Worry

Costs and Benefits of Worrying

What are the costs and benefits to you of worrying? What are the advantages and disadvantages of worrying? If you worried less, what do you predict would happen?

Example:

Jane is anxious all the time

She thinks “I can’t relax, I feel terrible, I hate exams”. The costs are that she is stressed out, loosing sleep, and not eating right. The benefits are that I will be motivated to study.

What do you think about the costs and benefits of your worries? Are they sometimes helpful?

Exercise: 2

Please write out the costs and benefits of a specific worry. Each time you begin to worry, use this chart

For example:

Specific Worry Costs Benefits

 

I think I have serious I can not relax, I will seek a medical

problem in my stomach I can not concentrate evaluation as soon

because I have pain on my work. Seeking as possible

medical treatment

 

Now It’s Your Turn

Specific Worry Costs Benefits

Turning Worries into Prediction

Many worries are expressed in vague or what if terms: it is difficult to test out worries that are really rhetorical questions or statements.

Example:

Sarah is a college student, she worries about her exams that is in 2 weeks.

In this example Sarah just predicts that her exam score will not be good. She does not have any reason for it. She is just guessing.

Exercise: 3

Please write down your worries in the left hand and then write the specific prediction you are making in the right. Please make specific rather than vague prediction. For example, instead of writing “My daughter might not get the job”, write “My daughter needs to update her resume”. This will teach you to think more logically about what worries you.

Exercise: 3

Worry Specific prediction

Testing Negative Predictions

When we make predictions about what will happen, sometimes, we think of the worst case scenario. What we have to remember is that things rarely turn out that bad. This will lead to less stress and better all around performance.

Example:

You had a poster presentation coming up and you are stressed out. You might predict “People are going to ask me all kinds of questions. I have to know the material inside and out. I have to be ready for any question and ready to defend against anything they say. I can’t embarrass myself up there. They’ll think I don’t belong there”.

But the actual outcome was different. “Things were a bit relaxed. I handled all the questions they asked. I was articulate in explaining things. People weren’t out to prove me wrong or challenge me. They just wanted to know what I’ve learned. I didn’t have to be so worried.

For the next exercise think of an event that happened, something you were nervous or worried about. Write what you thought would happen, and then write what actually happened.

Exercise: 4

What I Thought Would Happen What Actually Happened

When we approach things with worry and heavy stress, we forget about the progress we have made so far. When we make predictions (about the first day of work, a presentation, a reunion, etc.), we always assume the worst. But we don’t have to. We can approach things from a positive view. We can let optimism fuel our determination, not worry.

Part 2

Examining Past Predictions and Thoughts

When you are feeling depressed or anxious, you may get caught up in how you think and feel at the moment. You might think “I will be alone “or “I’m so depressed “, but if you were to look back on your negative thoughts in the past, you might find that there is a pattern: you often predict that negative events or feelings will continue indefinitely. By examining the past negative predictions that you have made, you may learn that your pessimism is rarely accurate. Making a prediction is a lot different than having a prediction come true. This is because our emotions tend to overwhelm us sometimes.

Have you made negative predictions in the past? Have they come true or not? Have you had past negative thoughts about yourself, others, and experiences that have not come true? You were worried about events in the past which you no longer even think about. List some of these past worries and ask yourself why they are no longer important to you.

Example

Judy recently separated from her husband because she felt she did not love him anymore. Even though it was her choice to separate, actually experiencing the separation triggered thoughts of loneliness that led her to feel depressed. She then predicted that she would never find anybody else to care about and that she would always be depressed.

Judy: This marriage was my second one and I have had a couple of significant relationships beside the 2 marriages.

When my past relationships ended, I always got depressed and felt hopeless just like now.

Ok… I can predict that when relationships end, I will think “I will never love anyone again"“ and “I will always be depressed. Yeah…I keep doing that, just like now. But I did love again, several times ….

I tend to make these predictions, but then I always have another relationship. So the pattern is, I will love again and I will get over my depression.

Another Example

Some people like Betsy are very anxious. They continually predict that they will have a panic attack, heart attack, or somehow lose control. For 4 years Betsy predicted that she would lose control and pass out on the subway.

Therapist: How many times in the past year have you taken the subway or bus?

Betsy: I avoid them when I can, but I would say about 25 times.

Therapist: How about over the last 4 years?

Betsy: I used to take public transportation more often, so maybe about 150 times.

Therapist: And what percent of time did you predict that you would faint?

Betsy: around 90%

Therapist: How many times have you fainted?

Betsy: Never

Therapist: Huh. That’s interesting.

Betsy: I guess these predictions are not coming out true.

Exercise: 5

Review some of the negative events in your life, or events that you thought were negative at the time. List your predictions and thoughts and then list the actual outcomes. For example, a past event might be “giving a talk” with the negative prediction or thought “I will look like an idiot” or “I will freeze up“. Then the actual outcome is “although I was nervous, the talk went ok”. You might also have made negative predictions that came true. Make a list of the different predictions that you have made in the past, going back as far as you can, then examine the actual outcomes.

Past Activating Event Prediction/Thought Actual Outcome

Giving a presentation I might freeze up. Although it was nervous,

it went ok.

Reviewing the Handling of Past Negative Events Description

Many anxious and depressed people predict outcomes that are negative, and many times they are wrong. But sometimes they are right. Bad times do happen to people. Sometimes they happen even if you don’t predict them. The real question is, have you ever been able to handle negative events? Research on worriers shows that when a negative outcome occurs, worriers actually handle it much better than they thought they would. This is an important finding, it suggests that part of worrying is underestimating ones ability to cope with negative outcomes. If the worrier believes that he or she can handle negative outcomes, then there will be less provocation to worry.

Example

Henry is a business consultant working for a medium sized company. His boss and he have had a number of conflicts in the past month, resulting in Henry’s fear that he will lose his job. Henry began to examine his ability to earn a living independently of the company, which was somewhat helpful, but his anxiety still persisted, then he decided to look at his past history of handling negative events.

It turned out that he was fairly skilled in handling negative events in the past, such as difficulties he had in college, finding the first job, dealing with his sons behavioral problems, and building up business leads in a company that was doing well. But it was not enough ….

One time Henry read a story about a psychologist. The psychologist had a patient who obsessed about getting sexually transmitted disease. Nothing seemed to help. The doctor and the patient reviewed all the things that one could do if he did get a disease, but the patient remained anxious. Then one day the patient came to the office and announced that, indeed, he had contracted syphilis. Much to the patient’s and therapist’s surprise, the patient responded with excellent adaptive skills to the situation, he obtained the proper medical treatment and quickly recovered. After reading this story, Henry told himself “I can do this”…….he got fired –but felt energized! He called all of his clients, and most of them were coming away with him into his new office, just like in the past he was a survivor.

In order to examine how you have done in handling negative events in the past, you can use the next exercise to list past the negative events and the ways in which you handled them. If you had problems handling negative events in the past, you will benefit from this and other exercises we are going to explore.

If you know that you handled past negative events well, you might want to examine what skills, resources, problem solving abilities, and other capabilities you brought to the table.

Exercise: 6 All of us deal with negative events from time to time.

Perhaps you do not think that you can handle negative situations that well. Think back to the negative experiences you had and identify ways that you were able to cope.

What did you eventually do to make things better? Also, identify some problematic or unhelpful ways of coping - for example, drinking, isolating yourself, pursuing no-win relationships, procrastinating, or complaining. Finally examine a current problem and identify some possible effective ways of coping and some ineffective ways of coping.

Past Negative Events How I Coped Unhelpful Ways of Coping

 

Unable to pay mortgage Talked to the bank, Yelling at the mortgage

payment explained the reason, company. Drinking.

  got a new payment plan Blaming spouse.

 

 

 

Current Problem To Cope Effectively Unhelpful Ways of Coping

Learning from Unconfirmed Prediction

Are you able to learn from your past negative predictions? Think back about your negative predictions in the past. Was any of them false? When you think back to the fact that some of them did not come true, what do you make of it? Do you discount this evidence of incorrect prediction? Do you think that somehow your new negative predictions must be valid?

Example Maria has discoloration in her face. She thinks it is a

sign of skin cancer. She has made this kind of predictions before.

Maria: Yeah …It s always something. Last year I thought I had AIDS. A couple of month ago I thought I had skin cancer. So….I have made a lot of predictions that have not come true. Actually there is evidence that this discoloration is not skin cancer. The doctor looked at it and said it is nothing to worry about. I have had this on my face before. But the doctor could be wrong. I should not accept what she says –what any doctor says –unless I can be certain. Otherwise I might regret it. …I should continue worrying and checking until I can be certain…

Exercise: 7 Example

Start with the automatic thought and then challenge it with a rational response. In turn, challenge the rational response. Keep going back and forth –challenging your previous response.

For example: I might have AIDS

AUTOMATIC THOUGHTS RATIONAL RESPONSES

What if the presentation goes wrong? I am prepared.

My boss will expect more. I have gone over this thoroughly.

He always finds something wring with Constructive criticism will help me

my presentations. improve.

What if he gets fed up, and fires me? If I’m not appreciated, I’ll find something

better. I’ll find a job I can enjoy. A better

opportunity.

Exercise: 7

Start with an automatic thought and then challenge it with a rational response. In turn, challenge the rational response. Keep going back and forth–challenging your previous response.

Automatic Thoughts Rational Response

Distinguishing Between Productive and Unproductive Worry

Many people who worry, will resist considering the idea that worrying doesn’t help. They are not wrong, worrying can be a helpful for preparation.

Let’s imagine that you are beginning a 700–mile drive. You might begin the journey with productive worries such as: Do I have enough gas? Have I checked oil and coolant? Do I know the way? Have I given myself enough time to get there? These are productive worries because they are focused on the most likely problems that are important to your trip.

In contrast, suppose your train of thought went in the following direction: What if I have a heart attack while I am driving? What if I get kidnapped? What if on my trip, my wife runs off with someone? Each of these worries describes something that is possible but unlikely, and describes something over which you have very little control. These are unproductive worries.

We can distinguish between productive and unproductive worries as the difference between a to do list and a what if list. A to do-list, leads to a set of reasonable actions that we can take. For example, I can check the gas, oil, and coolant. In contrast worries about heart attacks and kidnappings don’t lead to a to-do list. Thinking about these what ifs will only lead to a sense of doom and helplessness.

Example

Bruce is a student. He is worried about his exam.

Bruce: If I blow the exam, I will not get into law school and I will not get a job, ok these worries lead to worries about not making a living and then being a failure. I know some of these worries are unproductive. They are worries that are not plausible right now and I cannot really do much about. The worry that I might end up as a failure, without a job, is not something I can do anything about today. I can’t just go out and get a job because I am in school. Actually I have a lot of worries like that, like-what if my girlfriend leaves me? Or what if I get sick? But all of these worries do not lead to a to-do list for today and this week. The only thing on the do list is preparing for the exam.

I should only focus on things that I can do something about.

Another Example

Charlie has tinnitus. He is worried it will never go away.

Charlie: This tinnitus is so annoying. I am so stressed out. What if it never goes away? What will I do? How do I stop it? Actually, no one knows yet. I shouldn’t think this way. I have to think about what I can do about it. There might not be a cure for tinnitus yet, but there are treatments to help with the stress. The exercises will help me overcome the tinnitus, so I won’t be bothered by it so much. I should focus on those things. They can be my, to do list.

Exercise: 8

We all worry about something from time to time. The question here is whether your current worry is productive or unproductive. A productive worry is worry that leads to concrete, specific action. It’s a worry about something that has a good probability of occurring. An unproductive worry is worrying about what is possible–what could happen-but about things that are unlikely.

Think of something that currently worries you and fill in the answers.

My current worry:__________________________________________

Question AnswerIs this something with a low

probability of occurring?

 

What prediction am I making?

 

What is the problem that needs to be

solved?

 

What specific actions can I take ?

 

Do these actions seem reasonable?

Is this a productive or unproductive worry?

 

Why or why not?

 

You might begin to wonder whether your worries are irrational. However, not all worries are entirely irrational or without benefit. It is okay to worry about an upcoming physical fitness test or monthly bills. These worries let you know to prepare for them. You can put these worries into a to-do list.

Even with a to-do list, some may feel worried. While it is okay to worry, we don’t want it to interfere with our work or feelings throughout the day.

Assigning Worry Time

Sometimes people feel that their worrying is out of control. Assigning yourself time to worry gives back that control.

Exercise: 9 Example Assign 30 minute each day during which to worry

intensely. Write down all your worries, noting how anxious you are after the 30 minutes. Please use a time long before you go to bed. Sit down at the table–not on your bed–and write out all of the worries that come to mind. If you have any worries earlier in the day, write them on a piece of paper and put them off until the worry time. When you have done this exercise for a week, look back at your worries and see if there are some common themes that keep repeating themselves.

Write out your worries using the form below. Is there a pattern or a common term? Do these worries seem realistic?

Time/date: 5:00pm --- 5/15/13 Duration(min): 30 minutes

Place: Home

Anxiety at start of worry time(0-10) Anxiety at the end of worry time(0-10)

_8_ _5_

Worries: Will my boss notice the hours I’m putting in? What do I get my wife for her birthday? I have to get ready for Friday’s sales call. Do I know everything about the products? What’s my son up to this week? I should check in, maybe make some time for the weekend.

 

 

Common theme in my worrying: Letting people down.

Exercise: 9 Assign 30 minute each day during which to worry

intensely. Write down all your worries, noting how anxious you are after the 30 minutes. Please use a time long before you go to bed. Sit down at the table–not on your bed–and write out all of the worries that come to mind. If you have any worries earlier in the day, write them on a piece of paper and put them off until the worry time. When you have done this exercise for a week, look back at your worries and see if there are some common themes that keep repeating themselves.

Write out your worries using the form below. Is there a pattern or a common term? Do these worries seem realistic?

Time/date:_____ Duration(min):____

Place:_______________

Anxiety at start of worry time(0-10) Anxiety at the end of worry time(0-10)

______ ______

Worries:

 

 

 

 

 

Common theme in my worrying:

Examining If Thoughts Are Testable

Many people label themselves or make predictions that are based on thoughts or statements that can never be proven false. For example, you can consider how terms such as “worthless person” or “good for nothing “are not definable: we don’t even know what we are talking about when we use those terms. Ironically, we can get ourselves upset over something that is meaningless.

People should look at their thoughts as hypotheses or statements about what they think the facts are. Consider the following statements asserted as facts:

“Bill is 6 feet tall”

“I will fail the exam”

“It is going to rain tomorrow”

“She won’t talk to me”

“No one likes me”

We can “test” the truth of each of these statements by collecting information, making observations about what is true or false. We can measure Bill’s height, we can see how I do on the test, we can look outside tomorrow to see if rains, we can observe whether she talks to me, and we can collect information about whether people like me. These are testable thoughts that can be either true or false.

If there is no possible way to disprove a statement then the statement is pointless. Here are some examples of statements that are not open to disconfirmation:

“No matter what I do, I am worthless”

“Angels exist”

“There are spirits that control us”

“It is possible that I could go crazy”

“I need to know for sure”

Consider how much of these statements could be disproved or not

1) “No matter what I do, I am worthless“. How can I disprove this? Since you discount all evidence of behavior as indicating you are worthwhile, then you are stating as an axiom-as a statement that cannot be challenged-“I am worthless“ you are simply saying “I am worthless and there is nothing you can say that can change that belief”.

2) The statement “angels exist “also is not open to disconfirmation. We could confirm it only by observing angels, but since Angels are generally unobservable, the fact that we don’t see them proves nothing. We cannot possibly disconfirm the idea that angels exist.

3) The same thing is true about unobservable “spirits that control us”. We can not observe them, so we can not disprove any possible influence over us.

4) The statement “it is possible that I could go crazy “also cannot be disproved, since the possibility exists for everyone.

5) We all do many things-for example, drive to work, eat lunch, and start conversations. We don’t know for sure what’s going to happen next. Still, we go on. We can’t be worrying about things we have no control over.

Example

Terry: I don’t want to go to party, I am worried. I think I will screw up, but I guess if people talk to me and smile at me, it’ll be a positive outcome…Oh OK, that would be one way of showing that my negative prediction might be in accurate. Let me think…If I had a good time…If I met some people, had some conversations, and did not freak out...OK, let’s write those down as possible outcomes to see if my prediction is wrong.

Another Example

There is no way to stop the tinnitus from messing with my life. I’m worried that everywhere I go I’ll hear it and I won’t be able to relax or focus on anything else…But if I keep on doing those exercises, listen to sound therapy and learn new methods, it will start to work. I will learn to de-stress and overcome the tinnitus.

Exercise: 10

Using this table consider the thoughts that bother you. Example: I am a loser and I will fail. Indicate how you could test whether this statement is true or false. What would you need to observe or know to conclude that you are a loser or that you have failed? How would you know that you were not a loser and had not failed?

Thoughts How Could I Test It?

Something To Think About

Is there anything wrong with how your thoughts are stated?

Are they really testable?

Could we really collect information that could weigh against your thoughts?

Flooding Uncertainty

A lot of the time, we worry about things that are possible, but unlikely. For example, it’s possible to have a heart attack when anxious, but what are the chances of that actually happening? If we worry about everything that is possible, then we would worry about so much, we would have trouble functioning.

For example, it is possible that walking outside, someone with a mental illness could think you are a demon and attack you. But what are the chances of that happening? We get information about probability by looking at how often something generally happens in the real world. Something we refer to information about probability as the base-rate (or the percentage) of people who have headaches also have brain tumors? We would talk to all the people who have gotten headaches – which are just about everyone-and ask how many of these people also have brain tumors. It would be a very small percentage.

The Time Machine Often we believe that what is happening to us now

will affect us forever. We get caught up in the moment, and find it difficult to escape our emotions and our current perspectives. At times, we focus entirely on what is directly on front of us in that moment, failing to realize that our thoughts and feelings will change. When we are caught up in the moment, we cannot imagine feeling differently. When this happens we have to remember that we have been in painful situations before, and things do change.

First, think back and recall happy experiences. You could remember something funny between you and your friends, when someone expressed how thankful they were, or when you received good news. Notice how your mood changes when you think of these positive experiences.

The second part of this exercise involves something you are currently worried about. Can you imagine how you will feel about it a week from now? A month from now? A year from now? What about 5 years from now. What would be some reasons why you would be less upset about it in the future? You may be full or worry or anger now, but what will happen over time? Maybe you won’t think about it as much. You can call this the Time Machine Method.

Example

Tom is very upset about not doing well at work. His boss criticized his performance this week. Tom was embarrassed in front of his coworkers. He will use the Time Machine Method and remember a time when he was happy. Perhaps it was a time during his childhood.

Tom: I can picture myself sitting on the porch with my parents. It’s summer and we are drinking lemonade, it’s warm outside, but we are sitting in the shade and it’s cool. I feel relaxed and happy in this memory.

Remember

Going back to a pleasant memory is helpful way to lift your spirits. The next step is to think forward into the future. Notice how the further into the future you go, the less you will care about the situation now.

Example Continued

Tom: Let’s imagine a month from now. It might still come to mind once in a while, but I wouldn’t be so angry about it. I would be sure not to make the same mistake.

In 6 month from now, I probably would not care anymore. A year from now I would probably have forgotten about it. OK there were many things that have bothered me. Things that were devastating. I don’t even think about them anymore.

One way of changing worries is to put them in perspective – that is, to imagine how you would feel about these concerns in the future.

Another Example

Nathan has tinnitus. He is doing exercises to help him cope. They have helped him de-stress a bit, but progress is slow. Thinking on this, he is angry and frustrated. He uses the Time Machine Method to try and lift his spirits. First he remembers something from the past.

Nathan: Returning home. They were all waiting for me, holding up signs and calling my name. I didn’t know how happy I would be until I actually saw them. Then when we rushed in for that hug...I had never been that kind of happy. It was perfect……

Another Example Continued

My tinnitus is a problem. I don’t know how to deal with it yet. I’m angry, but 6 months from now… Practicing the exercises and listening to sound therapy, I might be more in control. These exercises would and sound therapy have helped me relax more, and deal with my tinnitus. I would get a good night’s sleep again.

A year from now, I would have a good handle on it. I wouldn’t be messing with me anymore. I might not even think about it anymore.

Exercise: 11 Use this table to write down something you are worried about and then indicate how

you would feel about these things at different times in future.

Worry:________________________________________________________

Time Ahead How I Will Feel About It

1 week

 

1 month

  

6 months

 

1 year

 

Sometimes people who feel hopeless believe that they will feel worse in the future. For example, a patient going through a breakup may believe that he or she will feel increasingly lonely in the future. In this situation, people should think what positive actions could be taken to handle loneliness –for example, joining activities or keeping in touch with people. Alternatively, they should recall if they had experienced losses before and how they were able to make progress in regaining a satisfying social life. Those who are worried might underestimate their ability to handle problems that arise, even though they have coped well in the past.

Time Machine (others)

Sometimes you are worried what other people are thinking about you, but people often stop thinking about things after a short period of time. Can you imagine using the Time Machine Method to see how people’s thoughts change about you? See how their thoughts change in a week, a month, a year in time. Will they be thinking about you, or are they thinking about something else?

Example 

Robert is an executive who fears that people would notice his anxiety at a meeting and they would form a lasting, negative impression of him. He thinks “they will see I am anxious, think I am weak, and word will get back to my boss”.

Using the time machine technique on him:

Therapist: Ok, let’s imagine you are at that meeting, who will be there?

Robert: Probably 6 executives from the other companies. I am the only one representing my company.

Therapist: Now, let’s imagine that someone named John is at this meeting, he is from company x. He sees that your face is flushed and he thinks “that guy is anxious “. How would that make you feel?

Robert: More anxious, embarrassed.

Therapist: Alright. Now, one of your assumptions is that people are thinking about your anxiety a lot. That might not be the case. I want you to describe to me, hour by hour, what john might be doing after the meeting ends.

Robert: Well, I don’t really know, but the meeting would end at around 11 A.M. and he will probably call his office, and then go to lunch.

Therapist: Is he thinking about your anxiety at lunch?

Robert: I don’t think so.

Therapist: Then what happens?

Robert: He finishes lunch and drives back to the airport, where he waits for his plane. Later he gets on the plane.

Therapist: Is he thinking about your anxiety?

Robert: No

Therapist: Then what happens?

Robert: He is probably doing work on the plane, maybe having a drink. Then, after a couple of hours, the plane lands and he goes home. Then he sees his family.

Therapist: Are there things that John might be worried about or thinking about during the day?

Robert: He might be thinking about whether the meeting went well for him or whether he has any problems on his job. He might wonder about his marriage or his health. There could be a million things.

Therapist: Does it seem likely that he is thinking about your anxiety?

Robert: No, he has other things on his mind. It is funny. It seems kind of conceited of me to think he would think about my anxiety.

Therapist: Well, it is probably not conceited, because it actually makes you feel badly when you think these things. But imagine if your automatic thoughts were true. Here is what it might look like. John is at the meeting noticing your anxiety. Some unfortunate things happen like he gets lost going back to the airport because all he can think about is your anxiety. Also, things like has trouble getting work done, and his wife feels he is ignoring her because when he gets home he just thinks about your anxiety. Far-fetched isn’t it.

Robert: Yeah. That’s not happening.

Therapist: So, if he noticed that you were anxious, how long do you think he think about it?

Robert: Maybe 10 seconds

Exercise: 12

Using this table write out the kinds of things that you are worried about –especially how you think it would appear to others, and what they might think of you. Then ask yourself, if you were in a time machine, what would they think about this in future, at the various times that are listed? What things (other than your behavior) would they think about?

Exercise: 12

My Negative Behavior:____________________

Time Things That The Person Will Do or Think

When It Happens

An Hour Later

Two Hours Later

Five Hours Later

Negation of Problems  

You are worried that something might go wrong. Let’s see if you can come up with some reasons why this is not a problem. Imagine that this thing happens–whatever it is. Can you think of some reasons why this might not be a problem–even if it did happen? You might want to think about how you could solve the problem. Put it in perspective, or even ignore it.

For example, if I say “you think it is a problem because it is raining outside“. You might respond with “that is not a problem because I have an umbrella” ok, let’s start. John that is out of work and is looking for a job….

John: I don’t have a job right now…ok, it is not a problem because I know I can get a job…but …there are a lot of people looking for a job…that is not a problem because I have an excellent resume. I have lots of experience….but…I have no structure to my day…ok that is not a problem because I can spend my day on my job search and I can exercise and see friends……but some people might think less of me because I do not have a job right now..It is not a problem because my friends and family are supportive and I do not have to care about what other people think…..

Exercise: 13 Please list something that you are worried about and then come up with

some reasons as to why these worries are not really problems.

Problem Why it is not a problem

Feared Fantasy Worry

A lot of time we worry because we are afraid that things might get worse. For example, you might be worried that you will not get to sleep in the next hour. But if we dig deeper, we might find the worry that you will get almost no sleep and will feel exhausted tomorrow. Here, we are going to ask you to try to identify that “worst fear”-the worry that you fear most. Then we want you to practice repeating this worry, over and over, until you become bored with it. 

 

For example: an individual may worry that he is spending too much money or that he is not earning enough. He thinks all of the ways that he could tighten his budget.

Frank: “I am worried that I will lose more money. If I lose more money then….then I will go broke….ok …so my real fear is not just losing money but going broke… To avoid that image or that thought, I’ll try to get reassurance from people…. I asked my wife what she thought. She told me that we can cut back on certain expenses. Things will work out”.

But for frank the real problem is being able to accept going broke. It is very hard to live with having that kind of thought. That is what he has to be practiced-the thought of actually going broke. There are some reasons he will not go broke.

Frank: “I have a few investments, my wife and I both have jobs. We won’t go broke. But I have images and thoughts of us going broke ….I see us as homeless, with no money…”

He closes his eyes and gets this image really clear in his head, and then repeats “we will go broke and end up homeless”…..he feels about 80% anxious from 0-100%

He keeps repeating this sentence and image for 10 minutes, and his anxiety drops to 5%

Frank:”I am feeling board with this”…..

That is because he can tolerate having the thought that he will go broke ….

Another Example

Riley: I’m worried my tinnitus will continue bothering me at work. It’ll mess with my numbers. Actually, my real fear is that this tinnitus will bother me forever. To avoid this thought (and make this future less likely), I will keep up to date with treatments for tinnitus while getting support from those around me. Treatments are improving every so often to help me overcome this tinnitus. Eventually I’ll get a handle on it. It doesn’t have to mess with my life.

Exercise: 14

First, identify the worst fears behind your current worry  and estimate the costs and benefits of those worst fears. Then focus on the image of the worst fear and repeat to yourself the statement that goes with it for 15 minutes. At 3 minute intervals, estimate and record your level of anxiety.

Exercise: 14

Identify Your Worst Fear Costs Of Worrying About This Benefit Of Worrying About This(behind your current worry)

 

Repeat the feared image and the statement that goes with it

3 minute intervals Anxiety(0-100%): _______

Some people believe that repeating a feared fantasy will make them feel worse. All of their effort has been focused on escaping their negative images through worry and reassurance seeking. If you think this way, let’s see how your anxiety changes the longer you hold the image in your head ……

Acceptance 

Rather than trying to control and change things, perhaps there are some things you can learn to accept and make the best of. For example, you won’t be perfect in your job, but you could learn to appreciate what you can do. Rather than criticize yourself for having a problem, start with “I accept that I have a problem with, for example, depression, and now I will try to find a solution to that problem.

We learn a lot of things in life. If you live in Vermont in the winter, you learn to accept the cold. If you live in Miami in august, you learn to accept the heat. Think about practicing a detached acceptance of what is going on. Act as an observer-someone who does not necessarily need to act. How would you describe what is going on without passing a judgment on it or recommending an action? Are there any advantages you might have as a detached observer? What would happen if you decide to be a detached observer and watch these events just go by?

Example

Therapist: Many times we worry about things we feel need to be controlled. But what if we aim for observing and accepting instead of worrying? When we observe and accept, we do not judge, we do not control. For example, if it is cold outside in January, we can observe it and accept it. No doubt we could wear warm clothing, but it is a reality with which we live. What if you were to aim for accepting the thing that you currently worry about?

Mike: I do not understand.

Therapist: Well, let’s take your worry that your aches and pains are a sign of terminal cancer. Even though your doctor tells you that all you need is exercise, you will still worry that you might die. Accepting your aches and pains means to observe them but not judge them. It means to simply describe. It means not interpreting just recording. How would you describe your leg?

Mike: I feel a little tension in my left leg. A small pain, sort of like a little needle..It goes away at times.

Therapist: How does your foot feel?

Mike: I noticed it does not feel unusual. I can feel my toes more in my shoe. I can feel a little warmth on the bottom of my foot.

Therapist: How about accepting eventually dying? What would that look like?

Mike: I can see myself as a dead body. I can see that I am not moving. I am not breathing. I stand back and see myself.

Therapist: How does that feel to stand back and observe?

Mike: I feel a little nervous at first, but there is a sense of calm as well.

Exercise: 15

We worry about many things in life, some that we can not do anything about. One technique that is useful is to practice acceptance. You already practice this acceptance in many areas on a day to day basis. You accept the fact that you are hungry, need to sleep, have to pay your bills, go to work, get stuck in traffic, or that it is hot or cold. You do not protest or worry about these things. Acceptance can involve becoming an observer who does not judge, interpret, or control. The observer sees and accepts. Let’s look at some of the things that you worry about and see how you could learn to accept them.