Anxiety Workbook

Manage your anxiety and live your life

About the Authors: Kris & Natalie Kris Kiczun lives in the North East of England, she has worked as a therapist for some years now and have dedicated her career to helping others live the life they want to lead. Kris became an occupa- tional therapist after experiencing difficulties in her own life and wanted to instil hope in people and help others to recover. Kris and Natalie have been colleagues and friends for several years now and it was Natalie who sug- gested they write this workbook together during the pandemic lockdowns. Kris couldn’t think of a better way to help people collectively. She has read many books and attended courses to help pa- tients and has regularly adapted materials to aid individual’s recovery. Everyone is unique in they’re learning style, we also prefer different coping strategies so we put this easy to read workbook togeth- er to help readers manage symptoms of anxiety. Kris is a great believer in using dynamic therapies such as walk and talk therapy, not sitting side by side with a therapist, walking side by side in the outdoors. This therapy is not a fitness session, but therapy in motion, it helps increase the blood flow to your brain which helps you tackle problems and can give you a new found sense of freedom. Not everyone needs to see a therapist and you can learn new skills from work books and practise what you learn. You and a friend can take turns in listening, this puts you on the same footing. Walking outside with a friend can help you feel safer, particularly if you have a fear of spaces, you can engage in socialising without the intensity of a formal discussion about your problems. It is not about how fast or how far you can walk, you can stop to sit down and have a cup of coffee. The workbook is an easily downloadable pdf form with separate worksheets for you to print off and use or why don’t you treat yourself to a nice journal and complete the easy to follow sheets into your book . Don’t forget to spend time completing the tree activity to show where you are now and again when you have finished the workbook so you can see your progress. ‘If you don’t like the road you are walking on, find another route’ Wishing you lots of success with the workbook!

Natalie also lives in North East England and a registered Mental Health Nurse with many years of experience working in various mental health settings in the NHS. Natalie and Kris work well to- gether in their different roles Mental health nurses have particular expertise in problem solving , strong communication and observational skills while an Occupational therapist can specialise in Therapeutic alliances, group process and socio emotional skills. Natalie came up with the idea of this workbook when she realised mental health services are be- coming increasingly difficult to access. As Kris said not everybody needs to see a therapist and more people are using self help work books to learn new skills to improve their own mental health. Natalie's passion is Dialectical Behavioural Therapy (DBT) for people who have suffered trauma, a consequence of this trauma is regulating emotions. Emotional dysregulation can lead to behav- ioral problems and can interfere with a person's social interactions and relationships. Natalie also believes that society now puts pressure on us to be perfect and living up to an unreal- istic ideal way of living and we can worry how others perceive us. This can lead to setting them- selves impossible standards and if these standards are not met people will not love me, essentially setting yourself up for perpetual failure, as a consequence this can lead to anxiety and depression. Everybody deserves to be happy. Therefore taking care of yourself – mind, body and soul — is of the utmost importance to build a Life Worth Living! Self-care is an important piece of that puzzle. Self-care is anything that helps support your personal wellness. When we don’t take care of our- selves we can feel exhausted, depleted and resentful. On the other hand, when we are practicing self-care, we tend to have more energy, feel better, think more clearly and make steps to accom- plish our goals. So…..be kinder to yourself . If you want a day lying on the sofa watching Netflix DO IT…...If you want to eat a full tub of ice cream DO IT……. If work is becoming difficult and you need time out DO IT…….Do all these things without feelings of guilt and punishing yourself with self—reproach. We will touch further on this in the workbook which I hope that you practice the tools with kind- ness and compassion and at the end you feel more confident Please take time to practice the tools and digest them taking all the time you need, Make this book work for you, you are the expert and know what's right, some chapters may work better than others . Do what feels right for you.

Contents Section one Section three What is anxiety? How to manage anxiety How it affects your body Grounding Difference between anxiety and panic Self soothing Distracting techniques Section two Five senses Mindfulness How can I live my life? Section four Unhelpful thinking styles Problem solving How to live life Coping strategies anxiety free Positive self talk Affirmations Self care

What is anxiety? Anxiety is a natural human response when we feel we are under threat. Gener- ally anxiety is experienced through our thoughts, feelings and physical sensations. Anxiety is what we feel when we are worried, tense or afraid, particularly about things that haven’t yet happened or things we think might go wrong in the fu- ture. Not many people with go through life without ever experiencing anxiety and particularly more common while coping with stressful events such as a bereave- ment or changes such as moving house, starting a new job. You can complete the Social Readjustment Scale on the next page , this will give you an idea of the amount of stress you might be experiencing. Ensure you in- clude everything you have experienced over the last 12 months. If an event mentioned above has occurred in the past year, or is expected in the near future, copy the number into the score column.

Am I experiencing stress or anxiety? There’s a fine line between stress and anxiety. Both are emotional responses, but stress is typically caused by an external trigger. The trigger can be short-term, it can happen when you are under pressure at work. Stress - People under stress also experience mental and physical symptoms, such as irritability, an- ger, fatigue, muscle pain, digestive troubles, and difficulty sleeping. Anxiety, on the other hand is caused by an internal trigger, generally automatic negative thoughts, in the form of excessive worries that don’t go away even in the absence of a stressor. Anxiety leads to a nearly identical set of symptoms as stress: insomnia, difficulty concentrating, fa- tigue, muscle tension, and irritability. Both mild stress and mild anxiety respond well to similar coping mechanisms such as physical ac- tivity, eating a healthy diet, and having a good sleep hygiene, but there are other coping mecha- nisms that we will cover later in the workbook. To understand how much stress you may have experienced you can complete the Holmes and Rahe Life Stress Inventory. To do this you can mark the value of each of the life events that have happened to you over the last two years then add up all of your points to calculate your final score. What Does Your Score Mean? 150 points or less: this is a a relatively low amount of life change and a low susceptibility to stress- induced health breakdown 150 to 300 points: there is a 50% chance of health breakdown in the next 2 years 300 points or more: there is enough 80% chance of health breakdown in the next 2 years, accord- ing to the Holmes-Rahe statistical prediction model. Disclaimer: This questionnaire is a prediction only of the effects of stress on individuals.



Scoring the Life Change Index The body is much like a well oiled machine and just like machines we do not like surprises such as running out of oil. Any sudden change in stimuli can affect the body, or the reordering of routines that the body needs to become used to can cause needless stress, throwing your whole physical be- ing into turmoil. The following chart will give you some idea of how to informally score yourself on a social readjustment scale. Since being healthy is the optimum state for us all , being ill is the state of being we most want to avoid. Life Change Units Likelihood of illness in the future 300+ about 80 per cent 150– 299 about 50 per cent Less than 150 about 30 per cent The higher your life change score, the harder you have to work to get yourself back into a state of good health. Based on the T.H. Holmes and T. H. Rahe, Social Readjustment Rating Scale.

Fight or flight or freeze response Anxiety is a physiological and biological response to threat , the threat maybe real or per- ceived. You may have heard of fight flight or freeze, this is your bodies natural response to danger. Think back to caveman days , there were threats all around us, scary animals rival tribes and so many other life threatening things When we heard or saw that tiger our mind and body spring into action and we either Fight– Not a good idea with a tiger Flight—Sounds like a plan Freeze– Stay very still and hope the tiger wont notice me In our cave man days we needed that response when we feel threatened however now we don’t have to run from tigers and we can ow feel threatened by going to new places, meeting new people, flying on a plane or problems with family, friends or work colleagues. When threat is perceived our bodies release stress homes into the body which causes Increased heart rate Rapid breathing Changes in blood flow: Increased blood flow to muscles necessary for escaping, such as skeletal muscles, and decreased blood flow to tissues not necessary for escaping, such as the smooth muscles associated with digestion Dilation of pupils Auditory exclusion, also known as hearing loss Tunnel vision, or a loss of peripheral vision in order to fully focus on the danger at hand Sweating to cool the body in response to the heat generated as your body gets ready to contend with a predator

These physical changes occur rapidly and automatically. If one were experienc- ing a life-threatening event, they would be expected. But, when they occur while picking up a few groceries for dinner or sitting in a meeting at work, they can be quite frightening. This prehistoric response could now be detrimental to our health physically and mentally Anxiety is when you feel scared or nervous about a situation, it’s a natural response that helps you react appropriately. We now feel threated by non threatening situations When does anxiety become a problem? Anxiety becomes a problem when it impacts on your ability to live your life as you want to. Anxiety will become a problem if ; your feelings of anxiety last for a long time your feelings of anxiety are strong you avoid situations that make you feel anxious you are feeling distressed and feel out of control you cant enjoy the things you love doing you cant complete everyday tasks It may also affect your ability to ; look after yourself hold down a job sustain relationships try new things

Why Is Having Some Anxiety A Good Thing? Imagine never being anxious or nervous: how would you know how to take care of yourself? How would you know not to run across a busy road? Or to mind your footing when walking along the edge of a cliff? Or to be cautious when approaching a potentially dangerous animal? Feelings of anxiety are there to guide us to take care of ourselves. Some people suffering from anxiety want to get rid of their anxiety complete- ly. Although this might sound attractive it would not be a sensible plan. The graph below shows why having some anxiety is a good thing.

When the sympathetic division of the ANS is activated, it stimulates some organs and inhibits others. The result is a state of general arousal. In con- trast, activation of the parasympathetic division leads to an overall calming effect.



Fight or flight or freeze response A persons ability to protect themselves from danger have developed gradually over time. When we feel under threat our bodies react by releasing hormones such as adrenaline and cortisol which can be help- ful and keep you safe. The hormones make us feel more alert and help us move faster The hormones also make our hearts beat faster , this sends blood to where its needed. Once the threat has gone, our bodies automatically release other hormones which help our bodies to relax. This can cause us to shake and is called the fight, flight or freeze response. Picture of the nervous system.





Scoring the Life Change Index The body is much like a well oiled machine and just like machines we do not like surprises such as running out of oil. Any sudden change in stimuli can affect the body, or the reordering of routines that the body needs to become used to can cause needless stress, throwing your whole physical being into turmoil. The following chart will give you some idea of how to informally score yourself on a social readjustment scale. Since being healthy is the optimum state for us all , being ill is the state of being we most want to avoid. Life Change Units Likelihood of illness in the future 300+ about 80 per cent 150– 299 about 50 per cent Less than 150 about 30 per cent

When does anxiety become a problem? Anxiety becomes a problem when it impacts on your ability to live your life as you want to. Anxiety will become a problem if ; your feelings of anxiety last for a long time your feelings of anxiety are strong you avoid situations that make you feel anxious you are feeling distressed and feel out of control you cant enjoy the things you love doing you cant complete everyday tasks it may also affect your ability to ; look after yourself hold down a job sustain relationships try new things

when you have anxiety symp- toms you might notice in your body



A churning In your stomach Feeling light headed or dizzy Pins and needles Restlessness Breathing fast Sleep problems Grinding teeth Nausea Changes in your sex drive Symptoms of anxiety on your mind Include: Feeling nervous and tense Having a sense of dread Feeling life is speeded up or slowed down Feel others know you are anxious Worrying about worrying Needing reassuranceLow mood and depression Ruminating – thing over a situation over and over again Losing time Feel disconnected from the world



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