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Interior	and
Cover


Interior	and
Cover

Designer:	Jamison	Spittler
Editor:	Camille	Hayes
Production	Editor:	Erum	Khan
Author	photo

©	Stacy	Vaeth	Photography
ISBN:	Print	978-1-64152-208-3	|	eBook	978-1-64152-209-0


Contents
Quick-

Start	Guide
Chapter

One:	Is	Anxiety	Running	Your	Life?
Section

I:	Feelings
Chapter

Two:	Your	Emotions
Chapter

Three:	Your	Body	&	Physical	Sensations
Chapter

Four:	Putting	the	Tools	to	Work
Section

II:	Behavior
Chapter

Five:	Avoidance	&	Escape
Chapter

Six:	Acceptance	&	Approach
Chapter

Seven:	Putting	the	Tools	to	Work
Section

III:	Thoughts
Chapter

Eight:	Thoughts	vs.	Reality
Chapter

Nine:	Getting	Unstuck	from	Thoughts
Chapter

Ten:	Putting	the	Tools	to	Work
Section

IV:	Staying	on	Track
Chapter

Eleven:	The	Road	Ahead
Chapter

Twelve:	Building	Your	Support	Network
Resources
References
About	the	Author


Quick-

Start	Guide
This	book	provides	a	variety	of	strategies	and	techniques	that	have	proven
effective	at	reducing	anxiety	and	its	most	troubling	symptoms.	Any	of	the
strategies	you	choose	to	practice	will	help	your	anxiety	overall,	but	I’ve
divided	them	up	here	based	on	which	type	of	symptom	they	target.	This
Quick-Start	Guide	will	navigate	you	straight	to	the	set	of	strategies	that	will
help	you	deal	with	acute	symptom	flare-ups	and	anxiety-producing	situations.
Section	I:
Feelings
Turn	to	the	strategies	starting
here

if	you’re	feeling	strong	emotional	or
physical	symptoms	of	anxiety.
•

Anger/irritability
•

Sadness
•

Hopelessness/despair
•

Insomnia
•

Mood	swings
•

Racing	heart
•

Shortness	of	breath
•

Dizziness
•

Stomach	upset
Section

II:
Behavior
Turn
here

if	your	anxiety	is	making	you	behave	in	ways	that	you	don’t	like	or
that	are	causing	you	problems.
Section	II

will	be	helpful	when	your	anxiety
causes	you	to:
•

Avoid	activities	you	used	to	enjoy
•

Avoid	certain	people
•

Frequently	cancel	plans
•


Avoid	certain	people
•

Frequently	cancel	plans
•

Call	in	sick	to	avoid	stressful	events	like	presentations
•

Feel	unable	to	do	routine	things	like	drive	or	go	to	the	store


•

Behave	uncharacteristically	in	anxiety-provoking	situations,	e.g.,	you	don’t
approach	or	talk	to	your	friends	when	you’re	at	a	party
Section	III:
Thoughts
Starting
here

,	you’ll	find	strategies	to	help	diminish	the	inaccurate	or
unhelpful	thinking	that	preoccupies	the	mind	when	you’re	caught	up	in
anxiety.	These	thought-focused	strategies	will	help	if	you’re	experiencing:
•

Chronic	worry
•

Repetitive	or	racing	thoughts
•

Catastrophic	(worst-case	scenario)	thinking
•

Self-defeating	thoughts	(e.g.,	“I	suck	at	this,	so	I	might	as	well	give	up.”)
•

Irrational	beliefs	(e.g.,	“If	I	don’t	drive	back	home	to	check	the	oven,	my
house	will	burn	down.”)
Welcome
Everyone	feels	anxious	at	some	point!	I	have	worked	with	anxious	clients	for
the	past	15	years	in	my	practice	as	a	clinical	psychologist.	Some	come	to	me
believing	that	their	anxious	feelings	can	improve.	Others	enter	therapy
reluctantly,	mostly	convinced	that	nothing	will	ever	reduce	their	panic
symptoms,	avoidance	behavior,	or	worried	thoughts.	People	who	improve
typically	have	two	things	in	common:
1.


typically	have	two	things	in	common:
1.

A	part	of	them,	no	matter	how	small,	believes	they	can	get	better.
2.

They	learn,	and	put	to	work,	effective	anxiety-reducing	strategies.
Simply	opening	this	book	and	reading	this	far	shows	that	some	part	of	you
believes	your	anxious	symptoms	can	get	better.	And	if	you’re	willing	to
engage	with	this	material	and	give	serious	thought	to	the	impact	anxiety	has
on	your	life,	there’s	a	part	of	you	that
wants

to	get	better.	Take	heart;	you
already	have	all	you	need	to	start	managing	your	anxiety	symptoms	and	living
a	happier,	more	fulfilling	life.
How

to	Use	This	Book
Psychology	is	a	young	science,	and	there’s	still	quite	a	bit	we	don’t	know.
However,	we
do

know	how	to	treat	anxiety.	Most	people	who	consistently	use
the	psychological	tools	in	this	book	will	find	relief.	My	clients	who	use	these
methods	tell	me	that	although	they	are	still	aware	of	their	worried	thoughts,
those	thoughts	no	longer	have	the	same	power	over	them.	So	instead	of


feeling	as	if	the	waves	in	the	ocean	are	pulling	them	under	and	they	have	to
fight	for	dear	life,	they	realize	they	can	float—even	in	a	stormy	sea.	They	ride
out	the	tempest	by	using	their	tools	and	knowing	that	the	waves	will
eventually	subside	and	the	sea	will	be	calm	again.
The	strategies	in	this	book	are	simple	to	implement.	They	are	all	evidence
based,	meaning	research	has	proven	their	effectiveness.	They	come	from
cognitive	behavioral	therapy	(CBT),	acceptance	and	commitment	therapy
(ACT,	pronounced	like	the	word
act

),	and	mindfulness	practices.
It’s	not	necessary	to	go	through	the	book	from	start	to	finish	in	order	to
improve.	You	likely	have	not	experienced	the	whole	range	of	possible	anxiety
symptoms	described	here,	so	you	may	choose	to	skip	some	sections,
depending	on	what	you’re	experiencing.	Although	this	is	not	a	workbook,	it	is
full	of	practical	strategies	and	instructions	for	how	to	implement	them.	In
each	of	the	nine	main	chapters	you’ll	see	sections	titled	“Go	Deeper,”	which
are	suggestions	on	how	to
take

the	strategies	to	the	next	level.	(You’ll	need	a
notebook	or	journal	for	these.)	The	“Go	Deeper”	strategies	are	optional,	but
they	are	a	great	way	to	maximize	your	results.


they	are	a	great	way	to	maximize	your	results.
A	NOTE	TO	READERS:

The	clients	in	the	examples	used	throughout	the	book	are	composites,
and	the	names	are	fictional	to	protect	anonymity.
Getting	Started
Keep	a	notebook	or	journal	handy	so	you	can	jot	down	your	thoughts	about
the	strategies	as	you	try	them	out.	Your	notes	will	help	you	reflect	on	what
you’re	learning	and	how	your	new	skills	can	help	you	better	cope	with
anxiety.	The	more	you	practice	and	write	about	the	strategies,	the	faster
they’ll	become	automatic	responses	to	your	anxiety	triggers.
Once	you	have	your	notebook	and	are	ready	to	start,	take	a	moment	to
think	about	your	schedule.	Consider	how/when	you	want	to	work	on	this
material	and	when	you	can	best	fit	it	into	your	general	routine.	To	really	get
up	to	speed	with	your	new	skills,	daily	practice	is	the	way	to	go—even	if	you
can	set	aside	only	a	few	minutes.	The	point	is,	give	some	thought	to	how
you’re	going	to	integrate	this	book	into	your	routine.
If

you’re	in	the	middle	of	an	acute	symptom	flare-up,	I	encourage	you	to
go	directly	to	the	relevant	section.	So,	for	example,	if	you’re	consumed	by
worried	or	intrusive	thinking,	start	with


worried	or	intrusive	thinking,	start	with
section	III,	“Thoughts”

.	If	your
anxiety	is	causing	you	to	avoid	important	events	or	people,	you	may	want	to
start	with
section	II,	“Behavior”

.	If	you’re	struggling	with	your	feelings	or
physical	health,	start	with
section	I

.
To	reach	longer-term	goals	of	sustained	peace	of	mind	and	inner	calm,


consider	breaking	the	material	down	into	small,	doable	steps	so	you
eventually	work	through	the	entire	book,	at	the	pace	that	suits	your	life.


CH

APTER	ONE
Is	Anxiety	Running	Your	Life?
Why	We	Struggle	with	Anxiety
A	snake	on	a	hiking	trail,	or	a	gun	in	your	face,	or	any	direct	threat	to	your
well-being	will	trigger	your	fight-or-flight	response.	When	this	happens,	the
sympathetic	nervous	system	releases	a	cascade	of	hormones,	in	particular
adrenaline	and	epinephrine.	These	stress	hormones	very	rapidly	cause	a	series
of	changes	in	your	body,	including	increased	blood	pressure	and	heart	rate,
slowed	digestion,	tunnel	vision,	shaking,	and	increased	muscle	tension.	All
this	prepares	you	for	a	full-throttle	physical	response	to	the	danger.	These
changes	come	together	in	an	instant,	to	create	a	singular	focus	on
survival

.
When	anxiety	is	appropriate—as	in	the	case	of	the	snake	or	the	gun—this
physiological	response	is	normal,	because	it	prepares	us	to	respond	to	the
potential	threat.
Even

when	the	perceived	danger
isn’t

life-threatening,	anxiety
can	still	be	helpful.	For	example,	a	student	might	need	to	achieve	a	certain
score	on	a	test	in	order	to	be	accepted	to	medical	school.	His	anxiety
motivates	him	to	study,	take	a	test	prep	course,	and	spend	considerable	time


on	practice	exams.	The	fear	of	failure	can	energize	and	focus	him	for	the	hard
work	ahead.	Or	a	person	driving	on	a	busy	highway	suddenly	experiences
increased	heart	rate	and	blood	flow	when	she	sees	someone	screech	to	a	halt
in	the	lane	next	to	her.	The	immediate	increase	in	heart	rate	prepares	her	for
action,	so	she	can	steer	toward	safety	if	she	needs	to.	These	kinds	of	anxiety
responses	may	not	be	saving	our	lives,	but	they	are	adaptive	and	keep	things
running	smoothly.
Anxiety	becomes	a	problem	when	a	person’s	fight-or-flight	response	is
triggered	by	cues	that	are	not	threatening	at	all—either	physically	or
otherwise.	For	instance,	the	person	who	obsessively	worries	about	their	health
even	though	tests	have	ruled	out	a	medical	condition.	This	person	is	unable	to
be	present	with	the	people	around	them	because	they’re	constantly
preoccupied	by	what	might	or	might	not	be	going	on	medically.	Or	take	the
person	who	fears	using	public	bathrooms	and	eventually	avoids	all	business
travel	in	order	to	not	have	to	confront	this	fear.	If	travel	is	necessary	for	work,
this	person’s	career	will	be	limited	or	ended	by	what	is,	at	its	core,	an
irrational	fear.
Anxiety


irrational	fear.
Anxiety

isn’t	just	a	problem	of	overreacting	to	things	happening	around


us;	our	anxiety	response	can	be	triggered	by	things	that	exist	only	in	our
minds.	This	happens	when	we	worry	about	and	anticipate	what-ifs	and	worst-
case	scenarios,	which	may	never	come	to	be.	Consider	the	person	who	feels
insecure	and	frets	relentlessly	about	the	possibility	of	doing	something	wrong
socially	and	being	embarrassed.	Eventually	their	social	world	becomes
smaller	and	smaller.	They	may	no	longer	go	to	social	events	and	may	even
stop	opening	up	to	people	they’ve	known	for	a	long	time.
If	you’re	holding	this	book,	you	likely	struggle	with	anxiety	in	some	way.
But	you	may	still	have	questions	about	whether	or	not	anxiety	is	a	problem
for	you,	or	about	how	serious	a	problem	it	is.	There	are	some	general	ways	to
assess	if	you’re	dealing	with	problematic	anxiety,	or	just	the	normal	fears	that
arise	in	life	from	time	to	time.
Anxiety	is
adaptive

when	it	comes	in	response	to	an	in-the-moment	fear
of	risk	in	your	immediate	environment.	Anxiety	is
maladaptive

when	it
becomes	a	chronic	state	of	tension,	worry,	and/or	avoidance	behavior,	all	of
which	negatively	impacts	your	life	and	functioning.
The	table	below	describes	the	differences	between	normal	fear	and
problematic	anxiety.
FEAR
ANXIETY


problematic	anxiety.
FEAR
ANXIETY
Fear	is	present-focused	and	generally	rational
in	that	it’s	responding	to	a	threatening	situation
or	event.
Anxiety	is	future-focused	and	can	easily
become	irrational	because	it	is	untethered	from
real	events.	Your	imagination	continually	calls
up	what-if	scenarios.
You’re	in	the	here	and	now.	There	is	a	fire	in
the	house,	and	you’re	figuring	out	how	to	put	it
out.	Once	the	fire	is	out,	your	fear	subsides.
You	feel	worry	and	discomfort	even	though
you	are	not	in	immediate	danger.	No	clear
threat	is	present	and	there	is	no	clear	way	to
solve	the	concern.
Fear	comes	from	real	threats	in	the	outside
world,	e.g.,	job	loss;	medical	diagnosis;	illness
of	a	loved	one;	threat	of	being	physically
harmed;	wanting	to	do	well	on	a	specific	task,
such	as	a	speech	or	an	exam;	wanting	to	make
a	good	impression	on	new	acquaintances.
For	the	most	part,	anxiety	isn’t	created	by	the
outside	world;	it’s	created	by	your	mind.	You
worry	about	possibilities	that	may	or	may	not
happen,	such	as:	“What	if	they	don’t	like	me?”
“What	if	the	plane	crashes?”	“What	if	I	can’t
leave	the	movie	theater?”	“What	if	they	hate
me?”	“What	if	I	have	a	panic	attack?”	“What


me?”	“What	if	I	have	a	panic	attack?”	“What
if	I	make	a	fool	of	myself?”
What

We	Can	Do	About	It
The	Anxiety	and	Depression	Association	of	America	estimates	that	40	million


people	suffer	from	anxiety	disorders,	which	are	the	most	common	issues	that
bring	people	to	therapy.	Thanks	to	decades	of	research,	we	know	a	good	deal
about	how	to	treat	them.	In	fact,	anxiety	symptoms	of	all	kinds	are	very
responsive	to	treatment,	offering	anxiety	sufferers	long-term	relief.	This	book
gives	you	access	to	some	of	the	same	tools	I	use	in	my	practice	to	help	people
struggling	with	all	types	of	anxiety	symptoms.
The	techniques	in	this	book	are	taken	mainly	from	three	scientifically
tested	and	proven-effective	interventions.	As	a	clinician	and	also	as	someone
who	struggles	with	anxiety,	I	have	personally	found	relief	using	these	specific
approaches,	and	so	have	my	clients.	I	believe	you	will,	too.
What	research	and	experience	have	shown	me	is	that	a	combined
approach	of	examining	your	thoughts,	accepting	(not	necessarily	liking!)
anxiety	as	a	part	of	your	life,	and	learning	to	be	more	present	in	the	here	and
now	are	the	essential	keys	to	reducing	anxiety	and	living	a	more	peaceful	life.
Having	anxious	thoughts	becomes	a	self-perpetuating	cycle	that	creates
more	anxiety.	We’ll	use	cognitive	behavioral	therapy	to	examine	and	change
your	thoughts.	Strategies	from	acceptance	and	commitment	therapy	will
help


help
you	behave	in	a	manner,	and	ultimately	live	a	life,	that	matches	your	core
values	and	desires,	regardless	of	your	mood	or	anxious	symptoms.
As	you	grow	to	accept	that	we	all	suffer	sometimes,	you’ll	find	there’s
more	room	for	you	to	separate	from	your	battle	with	anxiety.	Through
practicing	the	mindfulness	strategies	throughout	each	chapter,	you’ll	be	more
easily	able	to	bring	your	thoughts	back	to	the	here	and	now.	As	you	learn
ways	to	observe	and	distance	yourself,	even	if	only	slightly,	from	your
anxious	experiences,	you	will	be	less	overwhelmed	and	more	able	to
experience	joy	and	pleasure	in	your	life	now.
Habits	and	Neuroplasticity
Struggling	with	anxiety	can	be	so	demoralizing	that	we	give	up.	Similar	to
traits	like	height	or	eye	color,	people	who	struggle	with	anxiety	can	start	to
believe	that	they	were	born	anxious	and	there’s	nothing	they	can	do	about	it.
However,	the	reality	is	that	changes	in	our	environment,	along	with	learning
new	skills,	have	a	significant	impact	on	anxiety	and	can	lessen	anxious
symptoms	over	time.
Neuroscience	shows	that	neuronal	growth	and	structural	changes	in	the
brain	occur	as	the	result	of	new	experiences,	and	also	as	the	result	of	how	you


think	and	behave.	A	real-life	example	of	this	would	be	if	you
decided

you
wanted	to	change	your	habit	of	snacking	right	before	bed.	Perhaps	you’ve
eaten	chips	or	crackers	before	bed	for	years,	and	you	decide	to	substitute


sliced	vegetables.	The	plan	is	solid	and	you’re	ready	to	go.	However,	you’re
unlikely	to	be	successful	in	changing	this	habit	if	you	substitute	your	chips	for
veggies	only	once	a	week	or	every	couple	of	weeks.	On	the	other	hand,	if	you
consistently	eat	sliced	veggies	every	night	of	the	week,	or	even	just	most
nights	of	the	week,	your	brain	will	adjust	and	the	new	habit	will	take	hold.
When	you	repeat	a	new	behavior	enough	(which	continually	fires	the
same	neuronal	pathway),	the	new	experience	becomes	a	part	of	your	brain’s
system	on	a	chemical	level.	This	phenomenon	is	called	neuronal	plasticity,	or
sometimes	brain	plasticity.
SELF-

ASSESSMENT
Tap	Your	Growth	Potential
People	just	like	you,	with	similar	symptoms	and	levels	of	anxiety,	have
triumphed	over	anxiety	largely	because	they	believed	they	could.	Recognize
if	you	send	yourself	self-defeating	messages,	such	as	telling	yourself	no
amount	of	work	will	lessen	your	symptoms.	Just	having	these	thoughts	can
hinder	your	progress.
Take	this	assessment	to	see	how	much	you	believe	in	your	ability	to	grow	and
have	the	internal	peace	you	deserve	and	desire.	If	you	answer	yes	often,	let’s


plan	to	cultivate	your	capacity	to	believe	that	freedom	from	anxiety	is
possible.
1.

When	I’m	told	some	way	of	thinking	or	behaving	will	help	my
anxiety,	I	zone	out,	think	nothing	can	help,	or	that	this	person	doesn’t
get	it.
2.

If	I	have	to	work	hard	at	something,	I	feel	like	something	is	wrong
with	me.
3.

I	want	to	stay	just	as	I	am,	but	I	am	unhappy	where	I	am.
4.

I	don’t	believe	the	anxious	aspects	of	my	personality	that	bother	me
are	changeable	through	learning	and	new	experience.
5

.

Most	of	what	I	do	is	to	survive	and	get	through	the	day	and	less	about
what	I	want.
6.

I’d	rather	stay	stuck	in	anxiety	than	learn	new	ways	of	coping.
As	you	work	your	way	through	the	strategies	in	this	book	you	will	likely	start
to	believe	in	your	ability	to	grow.	Revisit	this	assessment	from	time	to	time	to
see	the	progress	you’re	making	in	believing	in	yourself.	In	time,	you	will	look
back	and	feel	both	surprised	and	proud	of	your	growth.


WRAP-

UP
•

Anxiety	is	a	normal	bodily	response	to	threat.
•

Feeling	fearful	about	something	in	your	immediate	environment	is
adaptive.
•

Imagining	what-if	situations	that	may	or	may	not	come	to	pass	is
maladaptive.
•

Anxiety	responds	to	treatment;	you	can	and	will	get	better.
•

The	brain	is	able	to	grow	and	change	structurally	as	the	result	of	new
experiences	over	time.
•

Believing	that	reducing	anxiety	is	in	your	control	and	hard	work	will	pay
off	makes	all	the	difference.	You	can	do	this!


What

You’ll	Learn	in	this	Section
Imagine	a	triangle	with	“Feelings”	in	one	corner,	“Behavior”	in
another,	and	“Thoughts”	in	the	third.	These	represent	the	three	main
paths	to	change,	which	lead	to	relief	from	a	wide	range	of	anxiety
symptoms.	This	book	is	divided	into	these	three	main	sections,	too.
A	change	in	one	corner	of	the	triangle	will	affect	the	other	two.
If	you	change	your	emotions—like	learning	strategies	to	calm	your
fear	and	anxiety	in	social	situations—then	you	will	likely	change
your	thoughts	(“When	I	calm	my	anxiety,	I	can	contribute	to	the
conversation	and	people	will	like	me”)	and	your	behavior	(you	stop
avoiding	social	activities).	Simply	put,	if	you’re	trying	to	effect
change,	you	can	start	with	any	corner	of	the	triangle.
In

this	first	section,	we	will	look	at	your	anxious	feelings,	both
emotional	(sadness,	anger,	mood	swings,	helplessness)	and	physical
(shortness	of	breath,	heart	palpitations,	insomnia).	You’ll	learn
better	ways	of	dealing	with	your	feelings	and	how	to	overcome
avoiding	or	pushing	your	emotions	away.	We	will	also	see	how	the
stress	of	anxiety	can	lead	to	unpleasant	physical	side	effects,	such


stress	of	anxiety	can	lead	to	unpleasant	physical	side	effects,	such
as	digestion	problems,	racing	heart,	and	chronic	headaches.
Together	we	will	uncover	what	lurks	underneath	your	anxiety,
which	may	be	the	most	important	factor	when	life	is	disrupted	by
anxiety.


CH

APTER	TWO
Your	Emotions
Are	You	Suppressing	Your	Emotions?
A	few	years	back	I	took	a	genetic	test	to	determine	if	I	was	at	heightened	risk
for	developing	certain	cancers.	I	did	this	at	the	urging	of	my	doctor,	who
rightfully	promoted	prevention	over	treatment.	This	thinking	made	sound
sense	to	me,	and	given	that	I	don’t	have	a	family	history	of	cancer,	I	believed
I	would	get	the	reassurance	of	longevity.	I	was	shocked	when	I	was	told	I	had
an	80	percent	lifetime	risk	of	developing	breast	cancer.	(The	average	risk	is
12	percent.)	I	distinctly	remember	thinking,	“This	can’t	be	happening;	there
must	be	a	mistake	in	the	test.”	The	information	was	too	overwhelming	for	me
to	process	emotionally	so	I	pushed	it	away.	As	a	result,	I	became	obsessively
focused	on	negative	thoughts	about	other	aspects	of	my	life.	I	was	unable	to
sleep	most	nights,	overwhelmed	by	worries	and	what-ifs.	What	I	wasn’t	doing
was	acknowledging	my	profound
sadness

and	grief.	Once	I	started	to	get	in
touch	with	the	vulnerability	I	felt,	the	anxiety	became	easier	to	manage.
The	more	we	avoid	or	push	away	our	emotions,	the	more	anxious	we


become.	This	self-defeating	process	is	a	learned	habit	that	actually	worsens
anxiety	over	time,	in	part	because	it	reinforces	anxious	thoughts	and	anxiety-
driven	behavior.	This	happens	because	to	keep	the	unwanted	emotion	at	bay,
we	have	to	continually	work	at	avoidance.	Over	time,	keeping	up	this
avoidance	becomes	something	else	we’re	anxious	about.	When	we,	despite
our	best	efforts,	drop	our	guard	even	for	a	moment,	the	pushed-away
emotions	come	flooding	in	and	we	again	anxiously	push	them	away.	On	this
merry-go-round	the	original	negative	emotion	goes	unaddressed	and	we
remain	ill	at	ease	and	hypervigilant.
STRATEGY:

CHECK-IN
How	Do	You	Feel	Right	Now?
As	you	learn	to	better	identify	your	feelings	you	will	gain	greater	emotional
control.	This	means	you	will	be	less	prone	to	intense	emotional	reactions,
such	as	panic	attacks,	emotional	meltdowns,	blowups,	crying	spells,	and
worried	thinking.	Plus,	knowing	what	you’re	feeling	means	you	can	address
the	real	issue	and	feel	better.	When	you’re	upset	or	aware	you’re	experiencing


anxiety,	use	the	following	chart	to	help	you	label	the	deeper	feeling(s)	that
may	be	underneath	your	anxiety.
EMOTIONS
PHYSICAL/BODILY
SENSATIONS
LABELS	TO
DESCRIBE
YOUR
EXPERIENCE
ACTION
URGES
EVOLUTIONARY
SIGNIFICANCE
LOVE
Calm	body,	relaxed
muscles,	sense	of	peace
and	well-being
Sense	of	comfort,
safety,	comfort	with
another,	passion,
sexual	longing
Desire	to	be
with	the
person,	to
bond	with
the	other,	to
make	sure
the	other	is
okay
Love	bonds
couples,	children,
families,	and	tribes.
It	is	the	glue	that
connects	people.
PLEASURE
Feel-good	hormones
released,	increased
energy,	lack	of	physical
pain,	excited	body
Delight,	joy,
vivaciousness,
contentment,
mastery,	feeling	lost
in	the	moment,	not
thinking	about	the
future	or	the	past
Urge	to
smile,
laugh,	talk
more	with
others,	and
reveal	more
about
yourself
Pleasure	is	a	tonic
for	negative
emotions	and
motivates	us	to	do
certain	things	in
order	to	experience
more	pleasure.
ANGER
Tense	body,	clenched
jaw,	tightened	muscles,
increased	body
temperature,	feeling	of
pressure	behind	the	eyes
Feeling	unfairly
treated	or
disrespected	by
others	or	the	world	as


treated	or
disrespected	by
others	or	the	world	as
a	whole,	outrage,
rage,	feeling	the	self
is	not	valued
Urge	to	be
aggressive
or	harm
another,
urge	to	yell
or	throw
something
Anger	cues	the
body	to	self-protect
through	physical
force,	self-assertion,
or	boundary	setting.
SADNESS
Desire	to	remain	still,
feeling	of	lethargy	and
lack	of	energy,	difficulty
getting	your	body	to
move
Loss,	grief,
hopelessness,
rejection,	feeling
defeated	or
unwanted,	feeling
bad	about	the	self
Urge	to	cry
or	sit	still	in
one	place,
lack	of
motivation,
urge	to
dwell	on
what	you
did	to	cause
the	loss
Sadness	is
protective	in	that	it
allows	the	self	to
mark	time	while
grief	and	problem-
solving	can	take
place.
ANXIETY
Stress	hormones	released
in	the	brain,	muscle
tension,	restlessness,
increased	heartbeat,
sweating,	shortness	of
breath,	stomachache
Being	worried	or
fearful,	feeling
threatened	by
something	in	the
environment	or
within	a	relationship
(fear	of	losing	a
relationship),	being
in	high-
alert/vigilant/survival
Urge	to	be
vigilant,
replay
events	in
one’s	mind,
predict
future
events,
desire	to
control	the
Anxiety	triggers


predict
future
events,
desire	to
control	the
Anxiety	triggers
adrenaline,	which
puts	the	body	into
high	alert,	primed
for	action	and
protection.


mode
threat,	flee,
or	be	busy
GUILT
Stomachache,	aching
muscles,	feeling	that	you
can’t	be	physically	at
ease
Feeling	like	a	“bad”
person,	feeling
destructive,	feeling
you	should	be
punished
Urge	to
make
amends,	to
be	a
“better”
person,	to
berate
oneself
Guilt	keeps	people
in	line	with	societal
laws	and	norms
designed	for
protecting	people.
SHAME
Burning	sensation	on
face,	cheeks	flushing,
stomach	sinking
Embarrassment,
humiliation,
exposure	as	a	fraud,
fearing	a	flaw	will	be
revealed	to	another
or	the	public
Urge	to	flee
the
situation,	to
become
invisible
and	hide
oneself
Shame	signifies
social	status	in	a
group	and	keeps
people	in
accordance	with
group	expectations.
STRATEGY:

EXPRESSING	YOURSELF
When	you’re	feeling	strong	emotions,	finding	a	way	to	express	those	feelings
can	go	a	long	way	toward	helping	you	move	through	them.	There	are
countless	benefits	in	talking	about	our	feelings	with	another	person.	For
example,	I	see	it	over	and	over	again	in	my	practice	that	a	person	comes	into	a
therapy	session	feeling	upset	or	anxious.	They	allow	themselves	to	talk	about


their	feelings	for	50	minutes,	and	they	leave	feeling	significantly	better.	Many
often	say,	“That’s	too	easy.	How	can	merely	talking	make	such	a	difference?”
The	answer	is	that	the	act	of	talking,	labeling,	and	expressing	moves
emotional	information	from	your	emotional	brain	to	your	frontal	lobe,	which
helps	you	better	understand	yourself	and	feel	more	in	control	of	your
emotions,	which	makes	you	feel	better.
Choose	a	person	with	whom	you	can	discuss	your	feelings.	Try	to	look	the
person	in	the	eyes	while	expressing	yourself,	because	maintaining	eye	contact
with	a	supportive	connection	will	further	soothe	your	nervous	system.
Emotional	relief	can	come	by	talking	with	others	with	whom	you	have
very	little	intimacy	or	contact,	such	as	a	therapist	or	support	group.	Even
talking	online	with	someone	you	don’t	know	that	well	may	help	you	feel
more	accepted	and	less	anxious.
Go

Deeper
Express	Yourself


As	you	explore	the	feelings	table	and	begin	talking	about	your	feelings,
write	down	in	your	notebook	the	emotions	that	seem	to	come	up	for	you
the	most.	Record	one	or	two	of	these	primary	emotions.	This	isn’t	a
writing	test	so	don’t	worry	about	your	writing	style,	spelling,	or
punctuation.	Simply	ask	yourself	the	following	questions:
•

How	old	were	you	when	you	first	remember	feeling	this	emotion?
•

What	was	the	situation?	Was	that	situation	at	all	similar	to	what
you’re	going	through	now?
•

Did	you	express	what	you	were	feeling	to	anyone?
•

Did	anyone	comfort	you	or	help	you	make	sense	of	your	feelings?
See	if	in	your	writing	you	can	comfort	yourself	now	through	self-
compassion	and	self-acceptance.	Tell	yourself,	“It’s	okay	to	feel	this
(your	specific	emotion).”	See	if	you	can	let	yourself	believe	that	part	of
the	problem	is	never	having	allowed	yourself	to	reflect	on	and	accept
your	deeper	emotional	experiences.
What’s

Underneath	Anxiety?
When	we	don’t	express	negative	experiences,	they	become	internalized—we
try	to	problem	solve	the	upset	in	an	internal	vacuum,	which	results	in


overthinking	and	a	sense	that	we	can’t	turn	our	mind	off.	Without	a	release
valve,	all	those	negative,	doomsday	thoughts	just	keep	bouncing	around
inside	our	heads.
Take	the	example	of	Zander,	a	typical	patient	in	my	psychotherapy
practice,	who	is	grief	struck	by	the	death	of	a	loved	one.	Instead	of	expressing
his	feelings	and	allowing	himself	to	be	openly	sad,	he	suppresses	his	pain.
Seemingly	out	of	nowhere	Zander	finds	himself	obsessing	about	the	details	of
the	loved	one’s	medical	expenses,	funeral,	and	the	what-ifs	now	that	the	loved
one	is	deceased.	Over	time,	his	world	becomes	smaller	and	smaller.	He	is
afraid	to	go	out	and	spends	most	of	his	time	at	home	ruminating	(working
through	negative	events	by	mentally	replaying	them	again	and	again).
Another	example	is	Valentina,	who	after	her	divorce,	blocks	the	normal
feelings	of	anger,	loss,	and	sadness	and	instead	becomes	obsessively	focused
on	her	weight.	She	replays	in	her	mind	what	she	did	or	didn’t	eat	that	day,
plans	her	next	meal,	imagines	herself	larger	or	smaller.	In	this	way	she
occupies	her	mind	to	avoid	confronting	the	hurt	and	upset	of	the	divorce.	The


avoidance	only	increases	the	loss	she	has	not	fully	experienced
emotionally,
and	so	she	clings	more	tightly	to	her	unhealthy	eating	patterns.


If	you’re	a	chronically	anxious	person,	you’re	likely	in	a	habit	of
suppressing	your	negative	emotions.	You	may	be	aware	of	your	anxiety	but
unwilling	to	explore	what	might	be	under,	or	driving,	the	anxiety.	As
uncomfortable	as	the	anxiety	feels,	it	can	still	feel	easier	than	managing	more
threatening	emotions,	such	as	anger	or	sadness	or	shame	or	guilt.	Let’s	take	a
look	at	how	to	start	doing	just	that.
STRATEGY:	EXPLORING	ANGER
If	you	struggle	with	anxiety,	the	moment	you	feel	an	ember	of	anger	brewing,
you	likely	blink	it	away.	Anger	is	adaptive,	evolution’s	way	of	motivating	us
to	protect	ourselves	through	boundary	setting	and	self-assertion.
1.

Build	awareness	of	anger.	Notice	when	your	body	gets	tight,	your	jaw
tenses,	or	your	heart	rate	increases.	Instead	of	going	to	your	automatic
anxious-spiral	default,	ask	yourself,	“What	feeling	might	I	be	resisting
right	now?”	and	“What	might	I	be	missing?”	and	“Is	anger	present?”
2.

For	10	minutes,	without	taking	any	action,	without	distracting	yourself
with	your	worries,	and	without	self-criticism,	tolerate	your	anger	being
present.
3

.


present.
3

.

Breathe	in	and	out,	simply	letting	yourself	be	aware	of	the	anger.
NOTE:

Becoming	aware	of	anger	doesn’t	mean	you	need	to	react	to	it.	One	client	I	worked	with
recognized	that	when	she	was	starting	to	become	angry	her	jaw	clenched	up.	Recognizing	this
anger	signal	helped	her	know	when	she	was	angry	long	before	it	became	intense	enough	to	be
self-defeating.
STRATEGY:	EXPLORING	SADNESS
Many	of	us	will	go	lots	of	other	places	first,	even	to	rage,	rather	than	willingly
feel	the	vulnerability	of	sadness.	This	short	meditation	is	a	safe	way	to	feel	an
uncomfortable	emotion,	by	inviting	it	in	rather	than	feeling	overwhelmed	by
it.	By	meeting	sadness	on	your	terms,	you’ll	have	the	advantage,	and	you’ll
start	to	learn	that	you	can	actually	tolerate	feeling	sad	and	that	it	isn’t	such	a
threat	to	you	after	all.
1.

Sit	comfortably	or	lie	down	on	your	back.	Close	your	eyes.	Allow	the
tension	in	your	body	to	release	as	you	breathe	in	and	out.
2.

Invite	sadness	into	your	conscious	awareness;	remember	moments
when	you	felt	sadness.
Consider

when	sadness	was	present	but	was


Consider

when	sadness	was	present	but	was
overlooked	and	unattended	to.	Review	your	relationships,	experiences,
achievements,	and	various	circumstances	through	the	lens	of	sadness.
3.

Now	be	a	gentle,	curious	observer.	Where	is	the	sadness	located	in


your	body?	Do	you	feel	tenderness	in	your	stomach,	behind	your	eyes,
a	feeling	of	fragility	or	vulnerability?	Maybe	you	can	observe	an	urge
to	cry	or	to	retreat.	Perhaps	your	heart	feels	tense	or	heavy.
4.

Recognize	when	a	voice	in	your	head	pulls	you	away.	Gently	direct
your	attention	back	to	your	sad	feelings.
5.

Your	suffering	only	wants	to	know	that	you	see	it	and	that	you	no
longer	have	to	hide	and	suppress	it.	Repeat	internally,	“I	see	you,
sadness.	I	feel	you.	I	am	side	by	side	with	you.”
6.

Feel	the	sadness	as	you	breathe	in.	Release	the	sadness	as	you	breathe
out.	Notice	the	feeling	as	it	comes	in	and	how	observing	it	allows	it	to
become	less	intense.
How

Do	You	Feel	About	Your	Feelings?
We	minimize	our	very	real	and	normal	emotions	by	telling	ourselves,	“It’s
bad	that	I	feel	this	way,”	or	“My	negative	emotions	mean	I’m	weak,”	or
“What’s	wrong	with	me	that	I	feel	this	way?”	or	“I’m	such	a	loser	because
I’m	always	upset,”	or	“No	one	will	ever	love	me	because	my	emotions	are	out


of	control.”	When	we	negatively	judge	our	emotions,	we	experience	double
the	emotional	pain.	On	top	of	the	original	hurt	or	upset,	we	feel	worthless	for
having	the	feeling	in	the	first	place.
Telling	yourself	you’re	a	weak	loser	for	a	feeling	you	can’t	help	but
experience	is	a	particularly	harsh	torment.	Take,	for	example,	Tanisha,	a	client
from	my	practice.	When	Tanisha	became	overwhelmed	by	sadness	or	anger	as
a	child,	her	parents	would	immediately	dismiss	her,	coldly	telling	her	to	“get
over	it”	and	that	she	was	“too	sensitive.”	Eventually,	whenever	she	felt	hurt,
lonely,	overwhelmed,	or	full	of	self-doubt,	she	learned	to	tell	herself	the	same
things:	“What’s	wrong	with	you?”	and	“Get	over	it,	no	one	cares!”	and	“Why
can’t	you	be	cool	and	keep	your	feelings	together	like	everyone	else?”	By	the
time	she	was	an	adult,	Tanisha	had	layers	of	unaddressed	negative	emotions
that	came	out	in	the	form	of	crushing	panic	attacks.
We	can’t	eliminate	anger	and	sadness,	but	we	can	control	how	open	and
kind	we	are	to	ourselves	when	we	experience	these	feelings.	The	next
strategies	are
designed


strategies	are
designed

to	help	you	let	go	of	judgment	and	allow	your	feelings
to	surface.
STRATEGY:	JUDGING	ANGER
By	changing	your	anger	associations,	or	judgments,	you	can	be	at	ease	with
the	emotion.	Take	a	moment	to	consider	what	you	associate	with	anger—


whether	memories	from	your	childhood	and/or	adult	experiences.
Write	down	in	your	notebook	four	or	five	specific	words	you	associate	with
anger.	Do	you	understand	why	you	associate	these	words	with	anger?	Where
did	the	judgments	come	from?	Were	they	ideas	you	got	from	observing	others
or	things	you	were	told	when	you	experienced	anger?	Are	your	associations
with	anger	mostly	negative?	If	so,	why?
Which	word	holds	the	strongest	association	with	anger	for	you?	Now,	reflect
on	its

opposite.
Can	you	think	of	ways	this	opposite	word	might	be	associated
with	anger,	too?
For	example,	for	many,	anger	brings	up	words	such	as	“out	of	control”	and
“destructive.”	Opposites	of	this	include	“constructive”	or	“useful.”
Expressing	anger	is
constructive

and
useful

when	done	in	a	respectful	way
that	allows	us	to	set	boundaries	and	take	care	of	ourselves.
STRATEGY:

JUDGING	SADNESS
Sadness	is	a	feeling	that	comes	about	due	to	grief,	rejection,	feeling	defeated,
unwanted,	or	unloved.	Typically,	each	of	these	instances	brings	on	a	sense	of
loss.	The	longer	the	sadness	goes	unaddressed,	the	more	and	more	anxious
you	become.


you	become.
Whatever	the	loss	may	be,	it’s	always	okay	to	acknowledge	your	sadness
about	having	missed	out	on	something	or	losing	something	very	dear.
Bring	to	mind	three	or	four	specific	occasions	when	you	pushed	away	the
feeling	of	loss,	grief,	failure,	or	rejection.
•

Were	you	honest	with	yourself	or	with	others	about	how	sad	you	really
felt?
•

Instead	of	feeling	your	sadness,	did	you	go	into	an	anxiety	spiral?
•

What	stopped	you	from	allowing	yourself	to	be	purely	sad?
•

What	kind	of	judgments	might	you	have	been	making	about	your	sadness?
•

Did	avoiding	the	sadness	help	or	hurt	you	in	the	long	run?
Letting

Go	of	Judgment	(short	meditation)
It’s	important	that	you	practice	observing	your	emotions	without	having	to
immediately	push	them	away.	Use	this	short	meditation	to	gain	perspective
and	space	from	your	moment-to-moment,	ever-changing	emotions.
Sit	quietly	and	comfortably.	Close	your	eyes.	Bring	your	breath	to	your


conscious	attention	by	noticing	your	chest	rising	and	falling.	Meet	whatever
emotion	or	feeling	arises	in	your	mind	with	your	inner	observer.
Your	inner	observer	carries	no	judgment.	Your	inner	observer	places	no
pressure	on	you	to	act	on	your	emotions.	It	merely	notes	what	you	are
experiencing.
For	example,	your	inner	observer	might	verbally	label:	“chest	tight,”
“anxious,”	“worried,”	or	“calm,”	and	“at	ease.”	If	your	inner	observer
becomes	aware	of	your	mind	making	judgments,	simply	label	it	“judging”	or
“thinking.”	Notice	how	when	you	observe	and	label,	the	feeling	state	passes
and	then	you	observe	and	label	the	next	feeling	state.
Nothing	you	observe	is	right	or	wrong.	Your	emotional	experience	needs
your	calm,	accepting	awareness,	nothing	more	and	nothing	less.
Turning

Toward	Difficult	Emotions
Our	culture	floods	us	with	the	message	that	happiness	and	success	depend	on
never	experiencing	suffering	or	painful	emotions.	Of	course,	we	all	feel
negative	emotions	at	times,	and	when	we	do,	we’re	left	feeling	defeated.
Feeling	that	we	must	have	made	a	terrible	mistake	somewhere	along	the	way
(why	else	would	we	be	feeling	so	bad?),	we	spin	our	wheels	doing	whatever


we	believe	necessary	to	avoid,	push	away,	or	somehow	“fix”	the	upset.
We	all	experience	negative	emotions,	including	anxiety.	No	one	is
immune.	Even	people	without	full-on	anxiety	disorders	go	through	anxious
spikes;	it’s	just	part	of	life.	Bringing	acceptance	to	your	emotional	world
means	giving	up	the	fight	against	suffering	and	pain,	so	you	may	be	free	in
spite	of	it.	And,	too,	it	means	recognizing	and	believing	that	experiencing
negative	emotions	is	normal.
Accepting	situations	and	experiences	doesn’t	mean	you	want	them	or	that
you’re	resigning	yourself	to	a	lifetime	of	emotional	pain.	Acceptance	doesn’t
mean	feeling	you’re	the	victim	of	your	pain	and	that	your	pain	controls	you.
Acceptance	doesn’t	mean	you	necessarily	like	what	you’re	experiencing.
Acceptance	is	the	idea:	“It	is	what	it	is.”
The	metaphor	of	the	Chinese	finger	trap	used	in	acceptance	and
commitment	therapy	clearly	shows	how	struggling	against	the	experience	of
difficult	emotions	only	increases	negative	emotion.	The	Chinese	finger	trap
is
a	small	woven	cylinder	that	children	often	enjoy.	You	place	a	finger	in	each
end	of	the	cylinder,	pull,	and—wham—suddenly	and	unexpectedly	your


fingers	are	trapped.	Trying	to	become	unstuck,	the	inexperienced	immediately
attempt	to	pull	their	fingers	out.	The	harder	they	pull,	the	tighter	the	tube


becomes,	evoking	fear	and	even	a	little	panic.	The	solution:	Push	the	fingers
toward	the	center	of	the	tube.	The	tube	becomes	slightly	bigger	and	then	it	is
easy	to	wiggle	the	fingers	out.
When	we	continually	push	away	and	avoid	our	experiences,	we	become
increasingly	afraid	of	the	negative.	Over	time,	we	stop	knowing	our	feelings
altogether.	Even	pleasant	experiences	like	joy	become	blocked.	We	are	no
longer	present	but	instead	live	in	a	survival	state,	waiting	for	the	next	shoe	to
drop.	This	crisis-state	existence	leaves	us	with	an	emotional	blind	spot.	After
all,	if	you’re	completely	focused	on	bailing	water	out	of	a	sinking	boat,	you
might	not	notice	the	life	preserver	at	your	side.	In	my	case,	spending	time
processing	and	ultimately	accepting	my	genetic	cancer	risk	as	a	reality	led	to
the	decision	to	undergo	an	elective	mastectomy	with	reconstruction—a	literal
life	preserver	that	I	was	unable	to	see	or	even	consider	until	I	accepted	my
situation	as	it	was.
Our	emotions	provide	valuable	information	and	guidance.	They	tell	us
what	we	want	out	of	life,	what	we	don’t	want,	how	we	feel	about	the	people
we	are	close	to,	and	what	we	need	to	work	on	within	ourselves.	Acceptance


allows	us	to	play	the	game	of	life	with	the	full	deck	of	cards.
Go

Deeper
Understanding	What	We	Learned	Early	On
Most	of	us	learn	how	to	cope	with	our	feelings	while	growing	up.	We
model	ourselves	based	on	what	our	parents	did,	what	they	told	us	about
how	to	handle	negative	feelings,	or	how	they	interacted	with	us	when	we
were	upset.	These	messages	can	play	out	over	a	lifetime	and	go
unchallenged.	For	example,	Juan,	a	client	I	worked	with,	came	to	see
that	whenever	he	was	upset	his	parents	told	him	he	was	fine	and	not	to
worry.	Although	well	meant,	this	only	increased	his	upset	because	he	had
no	outlet	to	talk	through	what	was	bothering	him	so	he	could	problem
solve	the	situation	and	find	true	relief.
Take	some	time	to	think	through	what	may	be	helpful	or	unhelpful	in
what	you	learned	growing	up	about	managing	your	emotions.	In	your
notebook,	write	about	any	or	all	of	these	prompts	that	resonate	with	you.
•

Did	your	caregivers	express	emotions?	Did	they	cry	or	get	angry?	Or
did	they	seem	to	have	a	tight	lid	on	their	emotions	and	rarely
expressed	frustration	or	sadness?
•


expressed	frustration	or	sadness?
•

Do	you	think	you	need	to	appear	in	control	of	emotions	all	of	the	time


or	do	you	feel	completely	out	of	control	and	so	try	to	clamp	down	as
much	as	possible?
•

Can	you	recall	any	expressions	from	caregivers,	coaches,	or	teachers
telling	you	that	you	are	“too	sensitive,”	“overly	needy,”	or	“too
emotional”?
•

Did	your	family	or	caregivers	describe	you	as	being	very
independent/mature	as	a	child?	Did	you	hear	a	constant	“good	girl”	or
“good	boy”?	Did	you	feel	as	if	you	couldn’t	be	a	kid	with	them?	Did
you	feel	there	was	limited	space	for	you	to	be	you	emotionally?
•

Consider	your	memories	of	joy	and	happiness	in	your	household	as
you	grew	up.	Do	you	recall	your	caregivers	laughing	among
themselves?	Did	they	notice	and	label	your	happiness?	Or	was	joy
squelched?
•

When	upsetting	things	happened	to	you	as	a	child,	did	you	feel	as	if
you	could	talk	to	your	parents	openly?	Or	did	you	feel	your	caregivers
would	judge	your	upset	or	overly	pressure	you	to	“fix	it”	in	some
way?	Did	you	not	confide	in	them	at	all?
Identify	the	link	between	the	type	of	emotional	support	you	were	given
in	childhood	and	how	accepting	you	are	now	of	your	emotional


in	childhood	and	how	accepting	you	are	now	of	your	emotional
experiences.	Start	changing	the	way	you	support	yourself	emotionally	so
you	can	be	more	unconditionally	accepting	of	whatever	you	feel.
STRATEGY:

PRACTICING	ACCEPTANCE
Although	it	can	be	hard	to	accept	painful	emotions—to	not	avoid	or	push
them	away—the	consequences	that	come	from
not

doing	so	far	outweigh	the
pain	of	facing	whatever	it	is	you’re	really	feeling.	Come	up	with	several
examples	in	your	life	where	your	lack	of	acceptance	of	your	feelings	has	only
caused	you	more	negative	emotion	or	wheel	spinning.
As	you	reflect	on	these	examples,	be	honest	with	yourself	and	acknowledge
the	#1	feeling	you	tend	to	avoid	that	brings	the	most	consequences	to	you—
sadness,	anger,	anxiety,	guilt,	shame,	frustration,	joy.
Consider	the	results	of	avoiding	this	emotion.	Has	it	increased	your	anxiety?
Caused	you	to	siphon	off	large	amounts	of	emotional	energy	in	vain?	Or	has
avoiding	this	emotion	blocked	joy	and	contentment?
STRATEGY:	SITTING	WITH	DIFFICULT


EMOTIONS
It	is	likely	you	have	avoided	negative	emotions	because	you’re	afraid	of
feeling	them	or	you	don’t	know	how	to	feel	them.	Here	is	a	way	to	do	just
that,	and	it	takes	only	10	minutes:
1

.

Set	a	timer	for	10	minutes.	Bring	to	your	conscious	awareness	an
emotion	you	tend	to	avoid	or	suppress.	Try	to	conjure	it	up	so	you	can
feel	it	right	now.
2.

Observe	where	in	your	body	you	experience	the	upset	or	discomfort.
Recognize	how	it	feels.	See	if	you	can	literally	visualize	the	feeling	as
you	experience	it	in	your	body.	Instead	of	fighting	the	feeling,
welcome	it	in.
3.

Whisper	out	loud,	“Welcome,	I’m	glad	you’re	here.”	See	if	you	can
observe	the	feeling,	almost	as	if	you	are	looking	down	on	a	physical
thing	separate	from	yourself.
4.

Internally	note:	“I	notice	a	feeling	of	––—	coming	over	me.”	Tell
yourself,	“I	am	making	room	for	you,”	or	“I	can	feel	this	feeling	and
also	be	okay.”
5

.

Notice	the	anxiety	that	drifts	over	you	as	you	allow	yourself	to	face	a
feeling	you	always	avoid.	It’s	okay	to	feel	this	anxiety.	It	makes	sense


because	you’re	afraid	of	this	emotion	and	I’m	asking	you	to	feel	it.
You	can	be	afraid	and	still	invite	the	emotion	in.	Show	yourself	you
can	enter	into	the	feeling	and	still	be	okay.
When	your	time	is	up,	move	forward	and	let	go	of	this	experience.
WRAP-

UP
•

All	emotions	are	a	normal	(and	helpful)	part	of	human	experience.
•

Pushing	away	negative	feelings	increases	anxious	thinking.
•

Regularly	identifying	your	feelings	will	decrease	anxiety.
•

Expressing	your	feelings	will	decrease	anxiety.
•

Accepting	your	emotional	world	will	decrease	anxiety.
•

You	can	experience	negative	feelings	and	still	be	okay.


CH

APTER	THREE
Your	Body	&	Physical	Sensations
Anxiety	and	the	Body
Cole	struggled	with	debilitating	physical	symptoms	including	lack	of	appetite,
racing	heart,	an	inability	to	concentrate,	feeling	internally	keyed	up,	and
insomnia	with	racing	thoughts.	These	distressing	symptoms	were	all	he	could
talk	about	because	they	were	so	unnerving.	Cole	understandably	felt	as	if	his
body	was	betraying	him	and	that	no	amount	of	anxiety-reduction	work	would
solve	this.
Anxiety	regularly	shows	itself	with	physical	symptoms.	At	some	point,
sometimes	after	years	of	experiencing	such	symptoms,	the	dam	breaks	and
the	body	will	no	longer	be	ignored.	For	Cole	this	meant	such	intense	heart
palpitations	that	he	would	become	dizzy	and	pass	out.	Other	people	might
react	in	a	different	way,	like	succumbing	to	acute	exhaustion,	or	no	longer
being

able	to	drive	because	of	severe	back	spasms,	or	being	unable	to
concentrate	because	of	persistent	headaches.	For	symptoms	like	this,	anxiety
treatment	begins	once	medical	causes	are	ruled	out.
When	I	see	clients	like	Cole	in	my	psychology	practice,	they	are	usually
surprised	that	“all”	they	have	is	anxiety.	For	example,	for	a	long	time	Cole


believed	that	eventually	a	specific	physical	ailment	would	be	identified	as	the
root	of	his	very	real	suffering.
Anxiety	impacts	the	brain	and	the	brain	impacts	anxiety.	In	other	words,
emotions	influence	our	physical	functioning	and	our	physical	functioning
influences	our	emotional	states.	Improving	our	overall	physical	functioning
and	body	awareness	can	make	all	the	difference.	Cole	eventually	became
more	at	ease	by	learning	to	observe	his	physical	sensations	and	taking	better
physical	care	of	himself.
STRATEGY:	BODY	SCAN
Anxiety	inhabits	your	body.	The	trick	is	to	start	tuning	in	so	you	can	more
quickly	recognize	the	physical	signals.	The	goal	of	this	exercise	is	to	develop
awareness	for	where	you	carry	your	anxiety.
1.

Pick	a	position	or	posture	that	is	most	comfortable	for	you—lying
down	or	sitting	up,	eyes	open	or	closed.	As	you	do	this,	let	go	of


judgment.	You	are	simply	observing	yourself	in	the	here	and	now.
2

.

Each	time	you	breathe	out,	feel	your	body	relax	as	it	releases	tension.
Recognize	when	your	attention	shifts	and	gently	direct	it	back	to	your
body	awareness.
3.

One	by	one,	focus	on	each	segment	of	your	body,	opening	up	to
whatever	is	present	in	that	moment.	Name	the	body	part	and	imagine
you	are	breathing	into	it.	Observe	areas	of	tension,	strain,	pain,	or	ease:
Head	…	Neck	…	Shoulders	…	Arms	…	Hands	…	Chest	…	Back	…
Stomach	…	Thighs	…	Calves	…	Feet	…
As	you	come	out	of	this	exercise,	make	a	mental	note	of	where	anxiety	tends
to	rest	in	your	body	so	you	can	tune	in	to	that	spot	more	quickly.
STRATEGY:	PROGRESSIVE	MUSCLE
RELAXATION
When	you	notice	a	spike	in	anxiety	and	your	body	feels	tense,	take	5	to	10
minutes	for	a	progressive	muscle	relaxation.	This	strategy	also	helps	when
you	can’t	sleep	at	night	or	to	downshift	into	relaxation	before	bed.
Lie	down	or	sit	comfortably.	In	turn,	tense	each	muscle	in	your	body	(face,


shoulders,	hands,	arms,	stomach,	buttocks,	legs,	feet)	while	breathing	in	for	a
count	of	5,	and	then	release	the	muscle	while	breathing	out	for	a	count	of	5.
While	doing	so,	pay	close
attention

to	the	contrast	between	your	experience	of
muscle	tension	and	muscle	relaxation.
Repeat	this	exercise	a	few	times.	Notice	your	body	loosen	and	gradually
become	more	at	ease.
Anxiety’s	Physical	Symptoms
The	body’s	stress	system	combined	with	heredity	and	environmental
experiences	over	time	can	set	the	stage	for	a	variety	of	chronic	medical
conditions.	Persistent	exposure	to	stress	through	psychological	trauma,	grief
and	loss,	life	transitions,	habitual	worry,	and	chronic	perfectionism	can
cripple	the	adrenal	system.	The	adrenal	glands	overwork	to	manage	the
ongoing	stress,	and	then	eventually	give	way	and	underwork.	The	result
creates	a	roller	coaster	of	anxiety	spikes	followed	by	exhaustion.	Exhaustion
can	lead	to	a	variety	of	medical	diagnoses.
Anxiety	is	also	linked	with	the	release	of	stress	hormones	and	chemicals
that,	over	time,	can	worsen	medical	conditions.	For	example,	research	is
showing	that	stress	and	chronic	pain	are	likely	linked	to	the	same	neuronal


pathway.	Nerve	pain	increases	the	expression	of	the	neurotransmitter	PACAP,
which	is	the	same	neurotransmitter	the	brain	releases	in	reaction	to	stress.	In
other	words,	stress	can	bring	on	and/or	worsen	physical	pain	symptoms.
The

body’s	biological	response	to	stress	can	also	significantly	impact	our
cardiovascular,	digestive,	respiratory,	and	endocrine	systems.	In	a	large	meta-
analysis	examining	over	20	studies	and	about	250,000	individuals,	researchers
found	that	anxiety	was	associated	with	a	26	percent	increased	risk	of	coronary
heart	disease	and	a	48	percent	increased	risk	of	death	due	to	a	cardiac-related
incident.
The	stomach	and	bowel	are	directly	impacted	by	the	body’s	fight-or-flight
response.	Over	time,	nerves	that	manage	digestion	can	become	reactive,
causing	unpredictable	abdominal	discomfort,	such	as	irritable	bowel	and
upset	stomach.	Although	the	symptoms	are	not	life	threatening,	they
significantly	impact	quality	of	life	and	can	be	quite	difficult	to	manage.	In
addition,	people	are	more	vulnerable	to	stomach	ulcers	when	the	stress
hormone	cortisol	is	released	on	a	chronic	basis.
Anxiety	is	often	present	in	people	with	respiratory	disease,	particularly
asthma	and	Chronic	Obstructive	Pulmonary	Disease	(COPD).	Fear	and	worry


impact	breathing,	making	these	illnesses	all	the	more	distressing.	The	stress
reaction	due	to	anxiety	is	also	linked	with	migraines,	rheumatoid	arthritis,
hyperthyroidism,	diabetes,	and	autoimmune	illnesses.
Unfortunately,	anxiety	is	often	not	considered	a	significant	factor	when
treating	these	complicated	and	often	debilitating	symptoms.	If	anxiety	is
overlooked,	medical
symptoms

may	become	worse.	Knowing	which	of	your
symptoms	are	anxiety	related	and	managing	them	will	improve	your	overall
physical	functioning	and	psychological	well-being.
STRATEGY:

WHAT	STORIES	ARE	YOU
TELLING?
There	is	a	back-and-forth	interplay	between	anxiety	and	medical	illness.	The
story	you	tell	yourself	about	your	medical	symptom(s)	and	how	it	impacts
you	physically	is	the	variable	we’re	going	to	focus	on	here.	Let’s	begin	with
an	example:
My	client	Sierra	endured	uncomfortable	bouts	of	gastroesophageal	reflux
disease	(GERD).	The	symptoms	were	so	painful	that	she	was	frequently
distracted	from	work	and	family	responsibilities,	slept	upright	at	night	and	so
slept	poorly,	and	despite	medication	had	a	perpetual	burning	sensation	in	her
chest.	By	the	time	Sierra	entered	therapy,	she	had	seen	a	number	of


gastroenterologists	without	gaining	relief.	When	I	talked	to	her	about	the
relationship	between	stress,	anxiety,	and	medical	conditions,	she	was
exasperated	and	felt	that	I	was	minimizing	her	genuine	physical	illness.	After
some	conversation,	Sierra	softened	her	view,	although	she	was	unable	to
believe	that	her	GERD	symptoms	could	be	helped	by	anything	other	than	a
medical	fix.
We

persevered.	She	started	practicing	mindfulness,	changed	her	diet,	and
studied	the	relationship	between	stress	and	physical	health.	Eventually	she
became	aware	that	her	GERD,	although	very	real	and	painful,	often	flared
after	she	experienced	a	stressful	event.	Armed	with	this	knowledge,	she
developed	stress-reducing	strategies	to	use	each	time	her	anxiety	was
triggered.	She	still	experienced	GERD	but	reported	that	the	intensity	of	her
symptoms	halved.	As	a	result,	her	symptoms	had	less	of	an	impact	on	her	life.
Your	perception	of	your	ability	to	manage	and	control	your	medical
condition	makes	a	difference.	Managing	anxiety	and	stress	better	will	not	take
away	your	medical	condition,	but	it	will	enhance	your	quality	of	life.	Reflect
on	the	following	statements	and	say	them	out	loud	a	number	of	times.	The


more	you	say	them,	the	less	you	will	feel	at	the	mercy	of	your	physical
symptoms.
•

I	believe	I	have	some	control	over	my	physical	symptoms.
•

I	believe	if	my	physical	symptoms	were	to	improve	it	would	be	due	in	part
to	anxiety-reduction	strategies.
•

The	way	I	think	about	my	physical	state	impacts	my	symptoms.
•

Exercise	will	likely	improve	my	physical	symptoms.
•

My	current	quality	of	life	could	improve.
•

My	medical	diagnosis	(or	physical	symptom)	is	not	entirely	out	of	my
hands;	I	must	persevere	in	living	a	less-anxious	life.
•

Stress-relieving	strategies	and	taking	good	care	of	my	physical	self	will
help	me	feel	better	physically.
Working	to	believe	these	statements	will	motivate	you	toward	healthy	self-
care.
Go

Deeper
What	Else	Could	You	Think	About?


Obsessive	thinking	is	a	way	to	avoid	facing	deeper	emotions.	Perhaps	we
worry	we	can’t	manage	the	painful	emotions,	or	perhaps	we	fear	they
will	overwhelm	us.
One	client,	Jack,	told	me	if	he	did	not	think	about	his	medical	condition
so	regularly,	he	would	begin	to	feel	a	tremendous	sense	of	helplessness
and	vulnerability.	He	felt	ineffective	and	powerless	if	he	was	not
preoccupied	with	his	health.	Hyperfocusing	on	his	body	and	medical
care	was	a	way	to	not	feel	like	a	victim;	a	way	to	take	charge.	With	his
obsessive	thinking,	Jack	felt	like	he	was
doing

something.	This	was
difficult	to	experience	and	express,	but	once	Jack	understood	his	real
fear,	we	could	productively	work	on	helping	him	feel	less	vulnerable.
One	way	we	did	this	was	by	looking	at	what	he
could

control	about	his
medical	diagnosis,	and	then	using	acceptance	strategies	to	deal	with	the
rest.
Jack	became	more	self-aware,	noticing	when	his	anxiety	was	triggered.
He	did	more	to	quickly	identify	the	sources	of	his	anxious	thoughts.	He
practiced
mindfulness

daily,	exercised	regularly,	ate	a	healthy	diet,	and


daily,	exercised	regularly,	ate	a	healthy	diet,	and
worked	on	breathing	and	positive	self-talk.	The	rest	he	turned	over	to	his
medical	team	and	the	universe.
Take	a	few	minutes	to	reflect	and	journal	in	your	notebook	about	the
following	topic:
If	you	did	not	fill	your	conscious	mind	with	thinking	about	your	medical
condition	or	physical	symptoms,	the	causes,	the	worries,	the	what-ifs,
and	fears	that	go	along	with	it,	what	would	you	be	thinking	about
instead
?
Explore	what	you	may	be	avoiding	or	missing	by	engaging	in	your
obsessive	thinking.	Then,	see	if	you	can	talk	yourself	through	those
deeper	emotions	and	find	a	way	to	accept	them.	Remember,	acceptance
is	not	submission;	it’s	a	way	to	take	different	steps	to	protect	yourself
than	the	ones	you’ve	already	taken.
STRATEGY:

TAKING	CARE	OF	YOUR
PHYSICAL	HEALTH
It’s	important	to	know	exactly	what	your	medical	situation	is,	otherwise	the
mind	is	free	to	imagine	all	sorts	of	alarming	scenarios.	And	appropriate
medical	intervention	is	essential.	If	you	have	not	done	so	already,	consider
making	an	appointment	with	a	medical	doctor	who	considers	the	whole


picture	of	physical	and	emotional	health.	Tell	your	doctor	about	your	physical
symptoms	and	also	your	struggle	with	anxiety.	Ask	your	doctor	for	a	medical
physical	with	blood	work	as	well	as	a	full	thyroid	panel	test.
Thyroid	imbalances	impact	anxiety	and	need	appropriate	medication.
Also,	make	sure	your	doctor	checks	your	vitamin	D	level.	Vitamin	D
deficiency	can	impact	mood	and	energy	level.	After	you	talk	through	the
results	with	your	doctor,	make	three	columns	in	your	notebook:
1.

Your	specific	medical	issue(s)
Example:

High	blood	pressure
2.

How	you’re	going	to	address	it	medically
Example:

Take	high	blood	pressure	medication
3.

How	you’re	going	to	address	it	in	terms	of	anxiety	intervention
Example:

Become	aware	of	anxiety	triggers;	practice	mindful
breathing	15	minutes	a	day;	exercise	four	days	a	week;	positive	self-
talk	(“Better	managing	of	my	anxiety	will	improve	my	physical
health”)
The

Mind-Body	Connection
I	want	you	to	remember	the	last	time	you	were	genuinely	frightened.	When	it
happened,	you	probably	experienced	an	increase	in	your	heart	rate,	change	in
your	breathing	pattern,	or	became	sweaty,	shaky,	or	jittery.	These	physical


symptoms	may	have	then	reinforced	your	original	fearful	thoughts.	The	mind
and	the	body	constantly	communicate.	If	your	mind	is	filled	with	a	sense	of
emotional	peace,	you	are	much	better	equipped	to	handle	medical/physical
challenges.
The	mind-body	connection	is	empowering	because	your	anxiety
symptoms	will	likely	improve,	or	even	disappear,	simply	by	taking	good,
consistent	care	of	yourself.	Healthy	sleep,	exercise,	and	nutrition	habits
usually	swiftly	improve	anxiety	symptoms.
STRATEGY:	SLEEP
Sleep	is	restorative	in	all	respects:	mood,	cognitive	functioning,	energy,	and
health.	Unfortunately,	when	we’re	anxious	we	do	not	reap	these	benefits
because	anxiety	typically	interferes	with	sleep.	People	who	struggle	with
anxiety	wake	up	to	intrusive	worries	during	the	night,	can’t	fall	asleep,	or
wake	up	too	early.


Creating

a	nightly	sleep	routine	places	cues	in	the	brain.	When	practiced
regularly,	the	cues	remind	us	that	it’s	time	to	start	unwinding.	The	key	is	to
follow	the	routine	consistently	so	you	become	accustomed	to	the	cues.
Eventually,	you	will	need	only	to	start	your	routine	to	feel	more	at	ease	and
even	sleepy.
Many	expect	to	go	from	alert	to	asleep	with	no	downshift	in	between.
There’s	a	middle	gear:	relaxation.	Here’s	an	example	of	a	good	nightly	routine
that	will	help	you	get	into	a	relaxed,	sleepy	state.	Work	to	develop	one	of	your
own	or	use	this	one.
One	hour	before	your	desired	bedtime	(ideally	the	same	time	each	night),
start	your	routine.
•

Unplug	from	technology.	Dock	your	phone,	tablet,	or	computer	away	from
your	bedroom.
•

Take	a	warm	bath	or	shower.
•

Change	into	sleep	clothes.
•

Drink	a	warm	decaffeinated	beverage,	such	as	chamomile	tea.
•

Do	a	relaxation	exercise:	meditate	through	deep	breathing,	visualize
relaxing	imagery,	practice	progressive	muscle	relaxation.
•

Lie	down	comfortably	and	read	fiction	or	something	light.
•


Lie	down	comfortably	and	read	fiction	or	something	light.
•

Turn	off	your	lights	when	you	feel	sleepy	and	your	eyes	start	closing.
•

When	you	can’t	sleep,	don’t	think,	“Why	can’t	I	sleep?!”	Tell	yourself,
“It’s	okay	if	I	don’t	fall	asleep,	at	least	I’m	resting.”	If	waking	up
continues,	try	progressive	muscle	relaxation	with	the	lights	off.
•

Don’t	worry	about	the	time	on	the	clock.	The	goal	is	to	relax	even	if	you
can’t	sleep.
•

Wake	up	at	the	same	time	each	morning.
•

If	you	didn’t	sleep	well	the	night	before,
don’t

take	a	nap	or	go	to	bed	at	an
earlier	time;	stick	with	the	same	routine.
IMPORTANT	NOTE:

Worry	often	appears	at	night	because	we	have	been	so	busy	during	the
day	we	haven’t	been	able	to	emotionally	connect	with	ourselves	so	all	the	things	we	haven’t
thought	about	crash	in	once	the	lights	are	out.	To	counteract	this,	set	aside	30	minutes	each	day
for	what	I	call	“total	worry	time.”	Take	out	your	notebook	and	put	all	your	worries	on	the	page:
Consider	how	you’re	feeling,	what	needs	to	get	done,	and	what	worries	you	about	the	days	or


weeks	ahead.	Then	when	the	lights	are	out,	your	brain	won’t	have	to	remind	you	of	everything
you	haven’t	thought	about	earlier.
STRATEGY:

EXERCISE


Anxious	energy	needs	a	release	or	it	will	continue	to	run	amok.	Adding
regular	exercise	into	your	life	will	pay	off.	Thirty	minutes	of	aerobic	exercise
five	days	a	week	will	lessen	your	stress,	increase	your	self-esteem,	improve
your	sleep,	and	improve	your	physical	and	emotional	functioning.	Feeling
good	about	yourself	means	you’re	more	likely	to	cope	well	because	you
believe	in	your	ability	to	do	so.
Exercise	also	increases	endorphins,	the	body’s	natural	painkiller,	and
decreases	the	stress	hormone	cortisol.	It’s	worth	it!	And	if	30	minutes	feels
like	too	much	too	quickly,	keep	in	mind	that	research	is	showing	that	even	a
20-minute	vigorous	walk	improves	cognitive	functioning	and	mood.
Make	a	realistic	exercise	goal.	Pick	something	you	enjoy	doing	so	you	will
continue	to	do	it.	For	example,	walk	every	day	for	15	to	20	minutes.	Then
after	two	weeks	increase	the	amount	of	time	or	increase	to	a	light	jog.	Be	sure
to	check	with	your	medical	doctor	that	exercise	is	safe	for	your	physical
condition.
Write	down	now	what	your	exercise	goal	is—no	goal	is	too	small;	any
physical	movement	is	better	than	none.	However,	each	time	you	exercise,	your


mood	will	improve	and	your	anxiety	will	decrease,	so	consider	doing
something	on	a	daily	basis.
When	experiencing	acute	anxiety,	employ	the	“10-minute	remedy.”	If	you’re
anxious	and	you	vigorously	exercise	for	10
minutes—

a	brisk	walk,	jogging,
bouncing	on	a	trampoline,	jumping	jacks—your	anxiety	will	decrease	almost
immediately.	Lifting	heavy	objects	or	weights	for	a	short	time	can	also	relieve
anxiety	and	tension.	Endorphins	are	released	and	you	will	feel	naturally	at
ease.	It	will	wear	off,	but	the	10-minute	remedy	is	a	quick	hit	for	anxiety.
STRATEGY:	NUTRITION
Start	looking	at	food	as	not	only	one	of	the	great	pleasures	in	life	but	also	as	a
natural	means	to	improving	your	emotional	functioning.	The	goal	is	to	eat	a
varied	diet	with	plenty	of	fruits	and	vegetables.	Rid	your	pantry	of	all
processed	foods	and	sugar.	Adding	a	variety	of	nutrients	and	decreasing	sugar
helps	the	body	regulate	insulin	and	hormone	levels,	which	directly	impact
mood,	anxiety,	and	energy	levels.
A	few	specific	tips	about	diet	and	anxiety:
Water:

Our	body	needs	water	to	function,	and	if	it	isn’t	functioning	properly,


mood	will	suffer.	Make	sure	you’re	drinking	8	to	10	glasses	of	water	daily.
When	experiencing	an	acute	bout	of	anxiety,	pour	yourself	a	tall,	icy	glass	of
water.	This	will	quickly	change	your	physiology,	turn	the	brain’s	attention	to


the	cold	sensation,	and	reduce	your	anxiety.
Caffeine:

It’s	astounding	how	many	people	who	struggle	with	anxiety	also
drink	a	lot	of	caffeinated	beverages.
Make

no	mistake:	Caffeine	increases
anxiety.	Decreasing	or	eliminating	caffeine	and	other	stimulants	from	your
diet	will	immediately	lessen	the	intensity	of	your	anxiety.	Consider	removing
all	caffeine	from	your	diet,	and	if	that’s	too	hard,	halve	it	and	work	down
from	there.
Nicotine	and	alcohol:

Both	nicotine	and	alcohol	have	short-term	rewarding
effects	on	the	brain	but	increase	anxiety	in	the	long	term.	If	you	drink	or
smoke	regularly,	take	a	break	and	see	how	you	feel.	For	some	people	this
change	alone	cures	their	anxiety	overload.
Nutrients:

If	you	have	any	vitamin	deficiencies	(check	with	your	physician),
you	may	benefit	from	taking	specific	supplements,	such	as	vitamin	D	or	a
daily	multivitamin.
Go

Deeper
Goal	Setting	for	Exercise	&	Sleep	(1-Week
Program)
In	order	to	make	a	long-term	impact	on	your	anxiety	and	give	yourself
an	emotional	boost,	consider	centering	your	goals	this	week	on	regular
exercise	and	sleep	hygiene.
Think	now	about	how	you	can	fit	in	30	minutes	of	exercise	each	day	this


week.	It	doesn’t	necessarily	have	to	be	at	the	same	time	each	day	but
remember:	Consistency	makes	it	easier	to	stick	with	a	routine.	Taking
care	of	yourself	needs	to	be	a	higher	priority	in	your	life,	so	you	might
have	to	give	something	up	or	put	to	the	side	something	that’s	important
to	you.
Then,	each	day	do	aerobic	exercise	for	at	least	30	minutes.	Jog,	speed
walk,	bike,	hike,	play	a	vigorous	sport	(soccer,	basketball,	tag	with	your
kids),	take	an	exercise	class.	Force	yourself	to	do	some	kind	of	activity
every	day	no	matter	what	else	is	going	on	in	your	life.	Even	when	you
don’t	want	to	do	it,	remind
yourself

little	in	life	pays	off	as	much	as	an
investment	in	exercise.	You	will	improve	your	physical	health,	your
emotional	health,	and	probably	live	a	longer	more	fulfilled	life—simply
by	dedicating	30	minutes	each	day.	Bonus:	The	release	of	endorphins
and	other	rewarding	hormones	will	help	you	feel	good	about	yourself.


As	we’ve	seen,	good	sleep	hygiene	is	perhaps	the	most	impactful	way	to
improve	mood	and	anxiety.	A	regular	nightly	wind-down	ritual	cues	the
brain	to	calm	and	switch	into	sleep	mode.	Make	that	a	goal,	starting	with
a	regular	bedtime.	Identify	which	sleep	aid	techniques	discussed
previously	you	will	incorporate	into	your	wind-down	habit.	It’s	essential
to	do	the	routine	consistently	and	at	roughly	the	same	time	each	night.
After	a	week,	journal	about	how	you	feel	physically	and	emotionally
compared	to	last	week.	Do	you	feel	any	more	positive	about	your	ability
to	cope?	Have	you	experienced	even	slightly	less	physical
tension/anxiety	this	week?	Could	you	continue	this	for	another	week?
Everyday

Body	Awareness
When	we’re	anxious,	one	worried	thought	replaces	another	and	another.	This
can	keep	us	so	stuck	that	even	a	few	moments	away	from	anxiety	feels
impossible,	but	it	is	possible	to	short-circuit	anxious	thinking	by	shifting	our
attention	to	our	physical	sensations.
Try	this:	Imagine	looking	at	the	sky	and	focusing	intently	on	one	small
black	cloud.	Now	pull	back	your	perspective	so	you	take	in	the	entire	sky,
horizon	to	horizon.	From	that	perspective,	the	black	cloud	loses	its


significance.	In	the	same	way,	switching	your	attention	from	your	anxious
thoughts	to	the	physical	sensations	created	by	those	thoughts	can	alter	your
perspective.
When	you	experience	an	anxious-thought	spiral,	observe	your	physical
sensations—tight	chest,	tense	shoulders,	racing	heartbeat,	whatever	they	are
—and	give	them	your	full	attention,	breathing	in	and	out.	As	you
acknowledge	it	(“I	see	you”	or	“There	you	are”),	it	will	likely	change	to	a
different	sensation.	Recognize	these	sensations	are	communicating	how	alive
you	are	in	this	moment.
STRATEGY:	MINDFUL	MOVEMENT
Use	the	simple	act	of	mindful	walking	to	ground	yourself	into	the	here	and
now	and	to	let	go	of	or	decrease	the	intensity	of	obsessive	thinking.	You	can
do	this	anywhere	and	at	any	time—walking	to	your	car,	walking
around

the
grocery	store,	walking	around	your	neighborhood,	or	walking	to	work.
While	walking,	focus	less	on	your	thinking	self	and	more	on	your	physical
experience.	For	example,	what	does	your	foot	feel	like	as	you	lift	it	and	lower
it	to	the	ground?	How	do	your	arms	feel	as	you	move?


Try	to	feel	the	earth	from	within	your	body.	What	is	that	sensation	like?	Does
the	sole	of	your	foot	on	the	ground	feel	heavy?	Can	you	make	it	soft?
Explore	each	of	your	senses.	Notice	what	you	feel	on	your	skin;	is	the	air	hot
or	cool?	Do	you	smell	anything	as	you	inhale	and	exhale?
Simply	observe	any	sounds	you	hear.	Notice	what	you	see.	You	are	here	in	this
moment;	feel	your	presence	and	your	alert	state	of	mind.
With	each	step,	mindfully	breathe	in,	and	breathe	out.	Count	your	steps	as	you
inhale	and	as	you	exhale.	How	many	steps	does	it	take	as	you	inhale?	How
many	as	you	exhale?	Keep	your	attention	on	the	steps	and	your	breathing.
Each	time	you	become	aware	of	your	mind	drifting,	gently	bring	your
attention	back	to	observing	what	it	feels	like	in	your	body	to	walk.	There	is	no
rush;	all	that	matters	in	this	moment	is	to	be	aware	of	your	body	as	it	glides
through	space.
WRAP-

UP
•

Anxiety	impacts	the	body	and	the	body	impacts	anxiety.
•

Learn	to	identify	and	observe	(without	judgment)	where	anxiety	manifests
in	your	body.
•


in	your	body.
•

Anxiety	is	associated	with	a	variety	of	medical	conditions.
•

Healthy	sleep,	nutrition,	and	exercise	habits	typically	improve	anxious
symptoms.
•

Practicing	body	awareness	exercises	helps	reduce	anxious-thinking	spirals.


CH

APTER	FOUR
Putting	the	Tools	to	Work
Your	intention	is	set.	Anxiety	will	no	longer	rule	your	life.	Now	you
know	it’s	within	your	reach	to	experience	a	peaceful	emotional	life
and	to	feel	physically	at	ease.	The	techniques	you’re	learning	in
this	book	can	reduce	anxiety	on	the	spot,	in	the	moment	that	it
arises.	Repeated	use	of	the	strategies	will	give	you	consistent,
sustainable	symptom	reduction.	Here’s	how	to	start	taking	the
techniques	to	the	next	level	through	building	longer-term	habits	and
goals.
From

Strategies	to	Habits
The	great	pioneering	neuropsychologist	Donald	Hebb	observed,	“neurons	that
fire	together	wire	together.”	Whether	it	be	learning	a	new	language	or
responding	to	an	abusive	parent,	repeated	experiences	over	time	trigger	the
same	patterns	of	neuronal	activity.	At	some	point,	only	a	tiny	cue	will	trigger
that	pattern	of	activity,	and	you	can	expect	the	same	events	to	occur	that	have
always	occurred	in	the	past.	For	example,	when	you	see	a	red	circle	in	the
distance,	your	brain	automatically	registers	“stop	sign	ahead.”	You	realize	as
you	approach	that	it’s	actually	an	advertisement	on	a	red	circle,	but	your
initial	perception	told	you	it	would	be	a	stop	sign,	so	you	had	already	started


downshifting	or	easing	your	foot	off	the	gas.	Because	old	patterns	of	neuronal
activity	fire	quickly	and	before	we	have	time	to	consciously	think,	changing
automatic	habits	can	feel	hard.
It	takes	about	90	days	to	build	a	new	habit.	This	is	roughly	enough	time	to
rewire	a	bit	of	your	brain.	It	does	take	discipline	and	effort	at	the	beginning,
but	with	practice,	the	new	coping	strategies	become	a	natural	part	of	your
functioning	and	routine.	Eventually	you	won’t	even	have	to	think	about	what
to	do	to	reduce	your	anxiety.	You	will	automatically	have	a	more	peaceful
way	of	being	with	yourself	and	coping	with	the	world.	This	is	the	payout!	To
cultivate	the	ease	and	calm	you	want,	stick	with	the	strategies	and	put	in
steady,	consistent	effort.
Planning
Take	a	wide-angle	look	at	how	your	life	is	organized	so	you	can	begin	to


think	through	how	and	when	you	will	integrate	the	techniques	into	your	day-
to-day	routine.
Outside	of	your	responsibilities—work,	school,	volunteering,	childcare,
social	life,	family	obligations—what	do	you	do	for	yourself?	When	you	do
have	downtime,	how	do	you	currently	spend	it?	People	with	anxiety	often	feel
as	if	their	downtime	is	unpredictable,	that	they	are	at	the	mercy	of	others,
their	schedules,	or	their	anxiety.	Stop	this	pattern	by	looking	at	the	big	picture
of	your	life.	Look	for	opportunities	where	you	can	deliberately	schedule
periods	of	time	to	work	on	your	anxiety	strategies.
Review	what	you	learned	in	the	last	two	chapters	(looking	at	your
notebook	can	help)	and	identify	which	techniques	you	want	to	start	with.	How
often?	What	times	or	days	of	the	week	are	best?	You	don’t	have	to	try	every
technique;	start	with	two	or	three	that	particularly	resonate	with	you.	Try	to
do	your	anxiety	work	at	the	same	time	or	times	each	day.	A	consistent	time
gives	the	brain	a	cue	that	will	speed	the	“neurons	that	fire	together	wire
together”	process.
Track	Your	Progress
Tracking	progress	works	for	many	things,	like	losing	weight	or	saving	money.
And	tracking	works	with	anxiety	reduction,	too.	It’s	essential	to	long-term


progress	that	you	set	up	a	system	where	you	track	on	a	daily	basis	the
strategies

you’re	using,	and	the	intensity	of	your	anxiety.	Here’s	an	example
of	a	quick	and	easy	way	to	track	progress.	Each	day,	check	any	and	all
strategies	you	use	from
chapters	2

and
3

.	Also	be	sure	to	rate	your
anxiety

for
the	day,	using	a	1	to	10	scale,	with	1	being	entirely	relaxed	and	10	being	full
anxiety	meltdown.	For	example,	you	could	create	a	table	like	this:
STRATEGY
MON
TUES
WEDS
THURS
FRI
SAT
SUN
How	Do	You	Feel
Right	Now?
✓
Express	Yourself
Exploring	Anger
✓
Exploring	Sadness
✓
Judging	Anger
Judging	Sadness
Let	Go	of	Judgment
(Meditation)
✓
Practice	Acceptance
✓


Sitting	with	Difficult
Emotions	(Meditation)
Body	Scan
Progressive	Muscle
Relaxation
What	Stories	Are	You
Telling?
✓
Take	Care	of	Medical
Health
Practice	Good	Sleep
Hygiene
✓
Exercise
Nutrition
Mindful	Movement
(Walking	Meditation)
Rate	Your	Anxiety	1	to
10	Scale
6
7
2
5
3
5
8
The

1	to	10	scale	is	a	way	to	look	back	and	see	your	progress.	At	first	you
may	have	quite	a	few	8s	or	even	10s,	but	ideally	over	the	course	of	a	month
you	are	going	to	have	more	days	with	5s	or	even	4s.
Goal	Setting
One	way	we	sabotage	our	goals	is	by	telling	ourselves	that	we	don’t	have	the
time	it	takes	to	make	a	change.	If	you’re	reading	this	book,	you	spend	time
worried	and	anxious,	yet	you	don’t	spend	quality	time	making	the	changes
that	will	nurture	your	mental	health.	Take	a	moment	now	to	make	a	goal	to
tackle	your	anxiety	by	doing	anxiety	strategies	on	a	daily/weekly	basis.
You	may	feel	vulnerable	acknowledging	to	yourself,	and	the	people	close
to	you,	that	you	want	to	improve	your	anxiety	and	that	you	are	going	to	take


deliberate	steps	to	do	so.	You	might	worry	that	you	won’t	be	successful.	It’s
sometimes	easier,	particularly	in	the	beginning,	to	say,	“I	can’t	do	it,”	or	“I
don’t	need	this.”	If	you	hear	yourself	saying	these	things,	it	might	be	because
you’re	afraid	of	failure.	If	so,	dig	deep;	believe	in	your	ability	to	change.	You
can	and	will	find	relief	from	anxiety,	provided	you	learn	to	believe	in
yourself.
When	it	comes	to	your	anxiety,	you	likely	try	to	deal	with	it	all	on	your
own.	This	is	hard.	Try	expressing	yourself;	tell	trusted	friends	or	family	and


get	their
support.

Sharing	a	bit	about	your	struggle	and	how	you’re	working
on	getting	better	will	make	your	goal	more	real	and	increase	your	likelihood
of	success.	And	it	will	boost	your	ability	to	believe	in	yourself.	Joining	an
anxiety	support	group	in	your	community	or	meeting	with	a	therapist	will	also
help	keep	you	on	task.
Another	way	people	self-sabotage	is	by	asking	too	much	of	themselves
too	soon.	Start	with	smaller	goals	and	build	from	there.	Even	a	little	bit	of
something	different	creates	the	scaffolding	for	more	and	more	growth.	Your
belief	in	your	ability	and	your	motivation	to	improve	will	strengthen	each
time	you	are	successful	and	each	time	you	check	off	implementing	a	strategy
on	your	calendar.
STRATEGY	OF	THE	DAY
Pick	a	strategy	from	this	section	that	resonated	with	you,	and	work	that
strategy	into	your	schedule	on	a	daily	basis	this	week.	Helpful	daily	strategies
include	practicing	acceptance,	letting	go	of	judgment,	and/or	mindful
breathing.	Before	you	implement	the	strategy,	visualize	yourself	doing	it.	For
example,	visualize	yourself	getting	up	a	little	earlier	and	practicing	mindful
breathing	for	10	minutes.	After	visualizing,	practice	the	strategy	in	real	time
each	morning.
STRATEGY

OF	THE	WEEK


each	morning.
STRATEGY

OF	THE	WEEK
Pick	another	strategy	that	you	can	work	into	your	calendar	at	least	three	times
this	week.	This	does	not	need	to	take	a	long	time;	choose	one	reasonably
achievable	for	you.	For	example,	this	week,	commit	to	brisk	walking	or	light
jogging	for	20	minutes	three	times,	or	schedule	a	full	medical	physical	with
your	doctor,	or	complete	the
“What	Stories	Are	You	Telling?”	strategy

.
Go

Deeper
Create	Your	Weekly	“Anti-Anxiety	Calendar”
Purchase	a	weekly	or	monthly	planner	or	use	your	digital	calendar	on
your	tablet	or	phone.	Then	look	over	the	current	month.	If	you	have	not
already	done	so,	write	in	any	work,	social,	and	family	commitments	and
appointments.
Habit	formation	comes	faster	when	we	teach	our	brains	the	behaviors
we’re	trying	to	cultivate	on	a	daily	basis.	Write	in	one	strategy	from	the


chapters	in	this	section	that	you’re	willing	to	employ	every	day	of	the
next	month.
Now	think	about	when	your	anxious	moments	might	be	during	the
coming	month.	Are	there	specific	days	of	the	week	or	times	of	the	day
that	you	anticipate	being	particularly	anxious?	Or	are	there	specific
commitments	that	always	trigger	your	anxiety?
Get

ahead	of	your	anxiety	by	identifying	strategies	to	use	before	you
encounter	anxiety-provoking	situations,	and	write	down	a	strategy	that
you	think	will	be	particularly	suited	for	that	specific	trigger.	For
example,	if	you’re	going	to	have	a	pressure-filled	meeting	at	work,	you
might	write	on	your	calendar	“express	your	feelings	through	writing”
when	you	get	home	that	evening.	Or	if	you’re	anticipating	being
annoyed	with	a	friend	or	family	member,	you	might	practice	“exploring
anger”	before	the	visit	so	you’ll	be	more	aware	of	and	better	able	to
manage	your	irritation.
Check-

In
It’s	all	too	easy	for	the	brain	to	slip	back	into	old	habitual	patterns.	One
extremely	effective	way	to	prevent	backsliding	is	to	make	a	regular	practice
of	checking	in	with	yourself	and	consider	the	ways	you’re
improving/changing.
When	you	check	in,	you	can	assess	what’s	going	well	and	what	you	might


have	lost	sight	of	on	your	path	to	a	peaceful	life.	And	you	can	recommit	to
persevering.	Rewiring	the	brain	takes	practice	and	time.
How	Did	You	Do?
Start	by	reflecting	on	how	you’re	doing	every	couple	of	days.	Then,	as	you
notice	your	symptoms	improving,	check	in	once	a	week	and	then	eventually
monthly.
•

How	successful	were	you	with	your	daily	goals?
•

How	about	your	weekly	goals?
•

Based	on	the	1	to	10	scale,	are	you	noticing	any	symptom	improvement?
Improvement	may	be	subtle	at	first,	but	any	reduction	in	the	intensity	of	your
anxiety,	even	going	from	an	8	to	a	7,	is	an	improvement.	If	you	weren’t	as
successful	as	you’d	like,	try	things	differently.	Look	for	other	ways	to	fit	in
the	strategies	and	be	honest	about	what	is	blocking	you	from	making	more
progress.	Remind	yourself	that	you	want	this,	and	you	can	and	will	do	it.


STICKING

WITH	IT
Whatever	you	do,	please,	please	be	sure	to	recognize	and	celebrate	your
successes.	I	have	worked	with	many	people	who	make	major	progress,	but
once	the	progress	is	made	they	minimize	or	dismiss	it.	When	that	happens,
they	self-defeat	future	progress.
For	example,	Hannah	started	therapy	not	being	able	to	get	a	moment’s	respite
from	panic,	feeling	on	edge,	and	muscle	tension.	She	was	so	consumed	by	her
constant	worries	that	she	could	not	be	present,	let	alone	enjoy	her	life.	She
made	the	decision	to	take	charge	and	became	gradually	more	at	ease
emotionally	and	physically.	Hannah	integrated	various	techniques	into	her
daily	routine	and	her	symptoms	improved.	She	started	working	again,
enjoying	sporting	events,	and	spending	time	with	friends.
Sometimes	she	would	have	a	reoccurrence	of	panic	and	find	herself	in	a
familiar	trance	where	her	entire	focus	was	riveted	to	worries	piling	up.	It	also
threw	her	into	a	self-critical	spiral.	Suddenly	thinking	she	had	made	no
progress	at	all,	she	would	abandon	the	strategies	that	had	brought	her	relief.
Progress

is	not	a	straight	line.	Setbacks	are	part	of	any	growth	and	change
process.	Anyone	who	has	raised	a	child	can	recall	a	baby	finally	sleeping


through	the	night	for	a	few	solid	weeks.	You	think	those	sleepless	nights	are
behind	you,	then,	ugh,	the	baby	starts	waking	again.
Nevertheless,	the	typical	pattern	is	for	setbacks	to	become	fewer	and	fewer
over	time.	Eventually	the	new	behavior	becomes	routine.
Every	couple	of	weeks,	reflect	on	where	you	started.	Remind	yourself	of	what
your	life	was	like	then	and	how	that	anxious	life	motivated	you	to	adopt	a
program	to	improve.	Freedom	from	anxiety	is	here	for	you.	Open	up	to	the
ease	and	calm	that	is	within	your	reach.	You	are	worth	the	investment.


What

You’ll	Learn	in	This	Section
Imagine	again	the	triangle	with	“Feelings”	written	in	one	corner,
“Behavior”	in	another,	and	“Thoughts”	in	the	third.	Any	change	in
one	corner	of	the	triangle	will	impact	the	other	two.	That	insight	is
at	the	core	of	all	the	strategies	in	this	book.	In	this	section,	we	are
going	to	focus	on	your	anxious	behaviors	and	how	we	can	change
them.	Anxiety	generally	results	in	two	main	behavior	patterns:
avoidance	and	escape.	These	two	patterns	of	behavior	allow	us	to
limit,	or	even	totally	eliminate,	our	contact	with	whatever	makes	us
feel	anxious.	Reducing	contact	with	anxiety	triggers	makes	us	feel
better	temporarily.	But	avoidance	and	escape	patterns	come	with
hidden	costs;	one	of	the	most	serious	costs	is	that	they	actually
increase	anxiety	over	time.
This

section	is	designed	to	help	reduce	your	anxiety-driven
behaviors.	Because	of	the	interconnectedness	of	those	three	points
on	the	triangle,	this	will,	in	turn,	also	help	reduce	anxious	thoughts
and	feelings.	For	example,	if	you	commit	to	taking	the	elevator
every	day	even	when	your	anxiety	tells	you	to	avoid	it,	you	will
change	your	thoughts	(“Hey,	elevators	aren’t	so	scary	after	all”)	and


your	feelings	(over	time,	you	won’t	experience	as	much	fear	when
you	take	an	elevator).
Responding	to	anxiety	with	avoidance/escape	behavior	makes
your	world	smaller	and	smaller.	Eventually	you	may	lose	tolerance
for	even	day-to-day,	basic	interactions.	As	we	explore	strategies	to
tackle	avoidance/escape	behavior,	we’ll	focus	on	specific	self-
defeating	habits,	doing	what	you	fear,	accepting	anxiety,	and
increasing	your	tolerance	for	uncertainty.


CH

APTER	FIVE
Avoidance	&	Escape
The	Avoidance	Paradox
Imagine	standing	in	front	of	a	beautiful	pool	on	a	sunny	day.	The	pool	is	full
of	swimmers	making	the	most	of	the	sunshine.	You’re	in	your	suit	and	poised
on	the	edge	of	the	water,	looking	as	if	you	are	ready	to	dive	in	and	join	them.
But	in	reality,	you’re	frozen	with	indecision.	Yes,	part	of	you	wants	to	jump
in.	You	want	to	make	the	most	of	life	and	enjoy	connection	with	others.	At
the	same	time,	a	big	part	of	you	dreads	the	shock	of	the	ice-cold	water.	You’re
stuck.	You	see	others	enjoying	the	pool,	laughing	and	frolicking	freely.	You,
however,	stand	on	the	side.	You	feel	alone.	You	feel	different.	You	pace.	You
sit	down.	You	start	to	imagine	people	are	staring	at	you,	and	your	anxiety
increases.	You	go	back	and	forth	in	your	head:	“Should	I	jump	in?	Or	not?”
You	nurture	your	initial	impulse	to	avoid	the	cold	water	with	more	avoidance.
As	a	result,	your	fear	grows	stronger.
Finally,

you	decide	to	sit	out	the	pool
experience.	You	feel	instant	relief,	but	feelings	of	self-consciousness	and


isolation	soon	arise.	Your	decision	to	avoid	limits	your	enjoyment,	your
spontaneity,	and	your	social	life,	because	your	fear	has	taken	control.
The	swimming	pool	is	a	simple	example,	but	there	are	many	ways	we
avoid	what	we	fear:	We	avoid	by	indecision,	by	not	showing	up,	by	not
following	through	on	commitments,	by	distracting	ourselves	with
meaningless	activities,	by	making	excuses	and	rationalizations.
No	longer	avoiding	what	you	fear	means	paying	attention	to	how	you	feel,
not	just	at	the	moment	you	avoid,	but	over	the	longer	term.	Sure,	avoidance
brings	a	temporary	reprieve—“I’m	dreading	facing	my	boss	today	…	ah,	I’m
going	to	call	in	sick	…	what	a	relief	to	not	have	to	deal	with	that	jerk!”	The
temporary	relief	reinforces	the	tendency	to	avoid.	But	the	reprieve	is	almost
always	short-lived.	New	anxiety	creeps	in	and	takes	over.	What	felt	like	the
sweet	taste	of	freedom	becomes	bitter	with	self-critical	thoughts	about	the
consequences	your	avoidance	may	bring.	What	will	your	boss	think	of	you	for
not	showing	up?	What	if	you	get	fired?	How	will	you	pay	your	bills?	Are
your	colleagues	criticizing	you	for	not	coming	in?


your	colleagues	criticizing	you	for	not	coming	in?
Far	from	relaxing	and	enjoying	a	day	off,	you’re	spinning	back	and	forth
in	your	mind.	Eventually	all	that	anxiety	keeps	you	stuck	in	avoidance;	you
don’t	go	to	work	not	only	that	day,	but	also	the	next	day	and
perhaps

even	the


next.	Now	you	likely	have	actual	negative	consequences	to	face.
Avoidance	feels	protective	in	the	short	term,	but	in	the	longer	term
generates	real	peril	and	more	anxiety	than	ever.	It’s	worth	keeping	in	mind
that	the	fundamental	problem	is	not	the	anxiety,	but	how	you	respond	to	it.
Hardwired	to	Avoid
The	fight-or-flight	response	is	produced	by	an	area	of	the	brain	often	called
the	“reptilian	brain”	due	to	its	primitive	nature.	The	reptilian	brain	evolved
very	early	and	relies	on	an	unsophisticated	operating	system;	within
milliseconds	we	flee	(avoid/escape)	a	perceived	threat	or	freeze	in	place,
before	we	even	process	the	apparent	danger.	From	an	evolutionary
perspective,	this	instant	all-or-nothing	response	is	effective	because,	after	all,
we	don’t	want	to	waste	precious	time	on	details	when	we	encounter	a	real
physical	threat.
On	the	other	hand,	the	reptilian	response	doesn’t	work	so	well	at	helping
us	figure	out	how	to	address	problems	that	provoke	anxiety	but	are
not
actually	threatening

.	And	in	modern	life,	that	describes	most	of	the	problems
we	encounter.	Even	a	genuinely	scary	situation—like	a	performance	review
with	a	boss	you	don’t	like—isn’t	an	immediate	threat	to	you.	But	your


reptilian	brain	doesn’t	know	this,	and	may	react	to	your	fear	with	a	fight-or-
flight	response	that’s	unhelpful	in	a	professional	setting.
In

other	words,	the	fight-or-flight	response	can	be	triggered	even	when
real	danger	doesn’t	lurk.	Once	the	information	regarding	the	perception	of
danger	makes	its	way	to	our	more	evolved	“upstairs	brain,”	we’re	able	to
rationally	determine	what	level	of	risk	the	threat	truly	poses,	as	well	as
problem	solve	and	act	strategically.	But	we	have	to	give	that	information	a
chance	to	get	there,	without	getting	stuck	in	the	response	generated	by	our
reptilian	brain.
When	Avoidance	Becomes	the	Problem
Ask	yourself	if	you	reflexively	avoid	or	overreact	to	things	that	pose	no	real
danger	to	you.	Things	that,	had	you	paused	and	considered	more	carefully,
you	might	have	realized	weren’t	actually	such	a	big	deal.
By	avoiding	the	things	or	situations	that	trigger	you,	you’re	essentially
deciding	that	they	are	too	much	for	you	to	manage,	when	in	reality	you	could
deal	with	them.	This	diminishing	ability	to	believe	in	yourself	only	increases
future	avoidance.	Among	other	misleading	thoughts,	your	anxious	mind
probably	seriously	underestimates	your	capabilities	(more	on	this	in


chapter	8
).	Let’s	look	at	how	to	start	changing	your	tendency	to	avoid.


STRATEGY:

WHAT	ARE	YOU	AVOIDING?
As	we’ve	seen,	avoidance	and	escape	only	beget	more	avoidance.	The
avoidance	loop	continues	because	it’s	a	habit	that	becomes	unconscious.	A
helpful	step	is	to	consciously	identify	what	you’re	avoiding	so	you	are	no
longer	doing	it	on	autopilot.
Take	a	moment	to	reflect	on	your	patterns	of	avoidance.	What	do	you
avoid	that	only	causes	you	problems	in	the	long	run?	Here	are	clues	that
suggest	you’re	ducking	something	that	matters	or	has	meaning	to	you:
•

Saying	you	will	do	something	but	then	not	following	through.
•

Procrastination:	delaying	a	task	until	tomorrow	…	then	the	next	day	…	and
the	next.
•

Making	rationalizations,	justifications,	and	excuses	for	why	you	can’t	do
something.	(“My	alarm	clock	didn’t	wake	me	up.”)
•

Wasting	energy/time	on	trivial	thoughts,	tasks,	and	interactions	as	a	way	to
distract	you	from	what	you	should	or	need	to	be	doing.
•

Frequently	telling	others,	or	yourself,	that	you	don’t	feel	well	physically
and	that’s	why	you	can’t	do	something.
Make

a	list	in	your	notebook	of	what	you	avoid.	Keep	this	focus	top	of	mind,


and	see	if	you	can	catch	yourself	in	the	moment	you’re	making	the	decision	to
avoid.	Then	try	to	make	a	different	choice!
STRATEGY:	WHY	ARE	YOU	AVOIDING	IT?
Even	dysfunctional,	self-defeating	behavior	continues,	or	increases,	when	it’s
rewarded.	People	keep	smoking	because	of	the	rewarding	effect	of	the
dopamine	hit.	Without	a	serious	desire	to	make	a	change,	this	behavior
continues	in	spite	of	the	toll	smoking	takes	on	health	and	longevity.
It’s	important	to	identify	what	is	reinforcing,	or	strengthening,	your
tendency	to	avoid	even	though	you	would	like	to	stop	this	behavior.
•

What	do	you
gain

each	time	you	avoid	the	situations	you	listed	in	your
notebook?	Some	people	report	feeling	a	sense	of	lightness,	like	they
dodged	a	bullet,	played	hooky,	or	got	out	of	something	truly	awful.
•

Do	you	celebrate	the	reprieve	as	if	you	won	a	prize	or	accomplished
something?	Who’s	really	winning?
•

Consider	if	avoidance	is	reinforced	because	it	means	you	never	have	to
fully	put	yourself	out	there	and	risk	rejection,	disapproval,	or	failure.


•

How	else	might	your	avoidance	be	reinforced?
Go

Deeper
What	is	Avoidance	Gaining	You?
Avoidance	is	a	short-term	fix	that	causes	more	and	more	anxiety	in	the
long	term.	Try	this	writing	exercise	to	inspire	motivation	and	focus	on
longer-term,	consistent	relief,	versus	quick	fixes	that	never	last	and	have
negative	consequences.
Write	down	two	lists	in	your	notebook:
1.

All	the	benefits	of	avoidance.	Be	very	honest	with	yourself	here;
no	one	else	is	reading	this	list.	Write	down	why	you	avoid	and	the
positive	feelings	that	come	when	you	do.	Try	to	emotionally
connect	with	the	feelings—for	example,	the	relief	of	pressure	or
the	power	of	managing	to	get	out	of	something.
2.

All	the	benefits	of	NOT	avoiding.	How	would	you	feel	about
yourself—improved	self-esteem,	proud,	less	shame,	strong?	What
goal	might	you	gain—greater	joy,	increased	productivity,	closer
friendships,	increased	work	competence,	increased	spontaneity?
Now

compare	the	two	lists.	Which	list	has	more	in	it	for	you	for	the	long
term?	Which	list	makes	you	feel	better	beyond	the	moment	and	also
helps	you	achieve	broader	goals	for	yourself?	Set	your	intention	now	on


what	you	want	going	forward.
Right

on	Target
Behaviors	that	you	want	to	reduce	or	change—like	problematic	avoidance—
are	what	psychologists	call	“target	behaviors.”	They	are	the	behaviors	that	we
will	target	with	our	interventions.	Target	behaviors	are	often	unproductive
things	you	continue	to	do,	even	though	they’re	self-defeating.
For	example,	Jase	feared	public	speaking	and,	as	a	result,	avoided	any
kind	of	group	meeting	at	work.	In	reality,	he	knew	his	job	well	and	wished	he
could	show	off	his	talents	through	public	speaking.	To	start,	we	targeted
Jase’s	pattern	of	skipping	meetings.	We	wanted	to	reduce,	and	ultimately
eliminate,	that	avoidance	behavior.	He	agreed	to	at	least	attend	work	meetings
but	not	put	any	initial	pressure	on	himself	to	speak.	Then	he	built	up	to
gradually	asking	a	question,	and	eventually	making	longer	and	longer


statements/comments	to	the	group.
Another	client,	Alisha,	obsessively	worried	that	her	boyfriend	would
break	up	with	her.	To	prevent	these	feelings,	she	sought	out	constant
reassurance	from	him	that	he	would	always	be	there	for	her.	Like	a	drug,	she
needed	another	and	then	another	hit	of	reassurance.	She	wanted	to	feel	safe
and	secure	in	the	relationship.	So	we	targeted	her	tendency	to	seek
reassurance.	She	agreed	to	reduce	requests	for	reassurance	by	25	percent	and
committed	to	simply	riding	out	any	resulting	anxiety	spike.	In	this	way	she
would	not	have	to	go	cold	turkey	but	could	begin	to	adjust	bit	by	bit.	It
worked.	Alisha	started	to	see	that	she	could	manage,	and	even	let	go	of,	her
fears	for	longer	and
longer

periods	of	time.	And	it	helped	Alisha’s	partner	feel
less	burned	out	and	more	compassionate	toward	her.
Tackling	avoidance	requires	pinpointing	target	behaviors.	The	table	lists	a
few	examples	of	goals	and	how	to	change	your	behavior	to	reach	them.
GOAL
TARGETED	BEHAVIOR	CHANGE
Increase	social	connection/closeness
with	people
Initiate	social	outings;	increase	eye	contact	in	social
situations
Increase	capacity	for	public
speaking
Every	work	meeting,	talk	for	at	least	three	minutes:	ask	a


Every	work	meeting,	talk	for	at	least	three	minutes:	ask	a
question,	make	a	comment,	or	clarify	something
Decrease	need	for	reassurance	from
partner
Learn	to	tolerate	fears	of	abandonment:	positive	self-talk,
breathing	exercises;	seek	reassurance	but	decrease	it	by
25	percent	(three	times	a	day	instead	of	four,	decrease
from	there)
Decrease	overthinking
spiral/rumination
Build	awareness	for	rumination	by	breathing	and	being
mindful;	talk	to	people	when	upset	instead	of	dealing
with	the	difficulty	only	in	your	head,	on	your	own
Be	present	and	participate	in	life
No	drug	or	alcohol	use;	build	awareness	of	when	you’re
spacing	out	or	daydreaming;	ask	questions;	be	an	active
listener
STRATEGY:

IDENTIFY	TARGETS
Based	on	your	goals,	identify	three	or	four	target	behaviors	you	would	like	to
change	because	they	get	in	the	way	of	your	larger	goals.
Rate	how	hard	it	will	be	to	work	on	each	of	these	behaviors.	Use	a	1	to	10
scale,	1	being	not	hard	at	all,	and	10	being	nearly	impossible.


Rate	how	motivated	you	are	to	work	on	each	of	these	behaviors.	Use	the	same
scale.
Start	with	a	behavior	that’s	not	going	to	be	too	difficult	to	eliminate	but	which
is	causing	enough	trouble	to	motivate	you	to	work	on	it.	So,	using	the	1	to	10
scale,	consider	behaviors	in	the	4	to	6	range	for	difficulty	and	at	or	above	5	on
the	motivation	range.	Once	you	make	progress	on	one	target	behavior,
momentum	will	develop,	and	you	can	work	on	other	items	as	you	wish.
The	Great	Escape
When	we	avoid,	we	work	behind	the	scenes	to	dodge	what	we	dread.	We’re
planning	ahead	to	totally	eliminate	contact	with	the	trigger.	Escape	is
different;	it	manifests	when	we	experience	an	acute	anxiety	surge	in	the
moment	we	contact	the	trigger.	We	then	do	whatever	we	have	to	in	order	to
get	away	from	it.	Imagine	what	you’d
do

if	you	touched	an	appliance	and	got
a	sudden	electric	shock—you’d	jerk	your	hand	away	immediately.	You	didn’t
manage	to	avoid	the	shock	but	you	did	escape	it,	and	minimize	your	contact
with	the	unpleasant	feeling.
For	example,	if	you	have	a	phobia	of	crowded	spaces,	you	may	be
perfectly	fine	most	of	the	time	living	in	a	bubble	that	keeps	you	in	your	open-


space	comfort	zone.	But	terror	can	take	over	if	for	whatever	reason	you
miscalculate	and	suddenly	find	yourself	in	a	crowded	corner	at	a	museum
reception.	Your	heartbeat	jumps.	Your	face	flushes.	You	shake	and	jitter.	You
may	even	think	you’re	going	to	pass	out	or	have	a	heart	attack.	Similar	to	a
fire	alarm	sounding,	these	panic	symptoms	cause	you	to	immediately	make
some	excuse	and	flee.
As	we’ve	seen,	an	adaptive	survival	response	in	a	true	emergency	can,	for
the	person	with	chronic	anxiety,	become	a	self-defeating	pattern	of	avoiding
uncomfortable	but	nonthreatening	situations.	When	that	happens,	a	person
may	find	themselves	in	total	escape	mode	for	situations	that	are	actually
benign—shopping	malls,	movie	theaters,	driving,	parties,	family	events,	work
meetings,	doctor’s	appointments,	just	to	name	a	few.	Giving	in	to	panic	and
fear	through	escape	means	no	new	learning	can	occur	because	you	never	get	a
chance	to	discover	if	what	you	fear	will	actually	happen.
STRATEGY:

REIN	IN	FIGHT-OR-FLIGHT
If	a	lion	is	attacking,	jump	off	a	high	wall,	run	toward	oncoming	traffic,	crash
through	a	sliding	glass	door—do	whatever	you	must	to	survive.	But	only


rarely	do	most	of	us	encounter	truly	life-threatening	situations.	In	those	other
circumstances,	the	ones	that	feel	scary	but	pose	no	real	threat,	you’ll	get	the


best	outcomes	if	you	rein	in	your	fight-or-flight	response	long	enough	for
your	“upstairs	brain”	to	kick	in,	so	you	can	make	an	accurate	risk	assessment.
Here	are	three	quick	and	easy	strategies	for	decreasing	the	physical	agitation
and	arousal—shortness	of	breath,	increased	heart	rate,	sweating,	shaking—
that	accompany	panic	and	anxiety:
1.

Take	slow,	deep	breaths,	feeling	your	chest	rising	fully.	Each	time	you
exhale,	make	the	exhalation	a	little	longer	than	the	one	before.
2.

If	you’re	too	keyed	up	to	breathe	freely,	count	your	breaths.	Counting
helps	distract	your	brain	from	anxious	thoughts.	Count	1	when	you
inhale,	2	when	you	exhale,	and	so	forth	up	to	20.	Then	start	again	with
1.	Repeat	this	a	few	times;	the	arousal	will	start	to	decrease.
3.

If	breathing	doesn’t	work,	place	your	hand	on	your	heart.	Notice	the
speed.	See	if	you
can

slow	it	down	with	your	breathing.	Put	all	your
attention	into	observing	the	beat	…	beat	…	beat	…	of	your	heart.
STRATEGY:	DO	WHAT	YOU	FEAR	(a.k.a.
EXPOSURE)


EXPOSURE)
We	reinforce	escape	behavior	by	never	staying	in	the	feared	situation	long
enough	to	see	if	our	anxious	expectations	are	accurate.	The	only	way	to	test
your	fears	is	to	put	yourself	in	the	situation(s)	that	ordinarily	make	you	want
to	bolt,	and	see	if	your	expectations	are	realistic.	Initially	this	is	going	to	bring
discomfort,	but	in	the	long	run,	it	will	lead	to	less	anxiety	and	less	escape
behavior.
1.

Get	out	your	notebook	and	write	down	situations	that	typically	trigger
an	urge	to	escape.
Example:

Driving
2.

Next	to	each	situation	write	what	you	believe	would	happen	if	you
stayed	in	the	situation	and	did	not	escape.
Example:

“If	I	keep	driving	when	I	have	heart	palpitations	and
shortness	of	breath,	I’ll	freak	out	and	crash	the	car.”
3.

Rate	how	likely	you	believe	each	of	your	listed	expectations	is	to
happen	on	a	1	to	10	scale	(1	being	not	at	all	and	10	being	extremely
likely).
4

.

Now	pick	a	situation	from	your	list	that	is	moderately	difficult,	not
painfully	difficult,	but	challenging	enough	that	you	feel	the	burn.
You’re	going	to	intentionally	put	yourself	into	this	situation	to	see	that


you	can	cope	better	than	you	imagine.
5.

Start	with	sticking	in	the	situation	for	a	short	time	and	gradually	build
up	from	there.	Remember	to	breathe	(use	the
“Rein	In	Fight-or-Flight”
strategy

)	during	this	exercise.	You	can	and	will	come	out	on	the	other
side	of	this	fear.
6.

Write	down	your	goal.	(We’ll	use	the	previous	example.)	Now	go	and
drive	the	car.	Continue	driving	for	15	minutes	after	panic	symptoms
(rapid	heartbeat,	shallow	breathing,	feeling	shaky)	are	triggered.	Use
purposeful	breathing	to	slow	down	your	breathing	and	heart	rate	so	the
“upstairs	brain”	can	tune	in	and	see	that	you’re	actually	safe.
7.

After	you	have	stuck	it	out,	ask	yourself	the	following:
•

Did	your	expectation	happen?	(“No.”)
•

What	is	the	evidence	that	it	happened	or	didn’t	happen?	(“I	felt	my
heart	beat	fast	and	I	had	shortness	of	breath	but	continued	to	drive	for
15	minutes,”	or	“I	did	not	crash	the	car.”)
•

What	did	you	learn	from	this	experience?	(“I	can	feel	anxious	in	my
body	and	still	drive	safely.”)
Go

Deeper
What	Would	Happen	If?