Home Study
- The Don't Panic Self-Help Kit,
Section P: Handle Your Physical Symptoms
Section "Start Here": How to Design Your Own Program - Don't Panic,
Chapter 18. Experience: The Greatest Teacher
These guidelines are for anyone who desires to control anxiety attacks and improve their ability to confront situations they currently avoid. This section will help those whose problems occur within panic disorder, a phobia, asthma, premenstrual syndrome, depression, or any of the other physical or emotional difficulties mentioned in this self-help program.
Here are the topics we will cover. Begin at the first one - "Set your long-term goals" - and progress through the fourth one - "How to practice your skills".
- Set your long-term goal
- Set your short-term goals
- Create short-term tasks
- How to practice your skills
Set your long-term goals
Panic exerts a force over you. It attempts to push you into a corner, where you feel trapped and afraid. To confront this force you must place some target in front of you, some positive goal to reach.
Creating your own goal will give you a clear sense of purpose. When you feel lost or confused, this goal can remind you of your positive direction. Let's decide to divide your goals into Long-term and Short-term. Long-term Goals represent your final desired outcome regarding your basic difficulties with anxiety. Short-term Goals focus your attention for only several days, weeks or months. Often there are several Short-term Goals for each Long-term Goal.
Identifying Your Long-Term Goals
- List all of the situations in which you have difficulty managing your anxiety and all the situations you avoid out of fear.
- Re-write each item to create a positive Long-Term Goal.
- If you have listed more than one Long-Term Goal, rank order them two times:
- from the least difficult to the most difficult
- from your most important, highest priority to your lowest priority
Start by identifying your Long-term Goals. Take time to follow these instructions, writing down each of your answers. First, list all of the situations in which you have difficulty managing your anxiety and all the situations you avoid out of fear. Then, re-write each item to create a positive Long-term Goal. Here are several examples:
CHANGE "I don't want to be scared in restaurants."
TO "I will feel safe in restaurants and comfortably enjoy meals with friends."
CHANGE "I'm anxious on planes."
TO "I will be able to regularly fly in a plane across country."
CHANGE "I avoid parties or large groups."
TO "I will feel in control at parties and will enjoy myself without drinking alcohol."
CHANGE "I'm afraid to drive far alone."
TO "I will feel confident as I drive alone any distance I desire."
If you have listed more than one Long-term Goal, rank order them two times: first, from the least difficult to the most difficult; and second, from your most important, highest priority to your lowest priority.
Set Your Short-Term Goals
In addition to Long-Term Goals, mastering panic will require a smaller goal, which I call your "Short-term Goal." This Short-term Goal will be your set of immediate tasks that moves you closer to your long-term goal.
Setting Up Short-Term Goals
- From your Long-Term Goal list, pick the two goals ranked least difficult, and the two highest priority goals.
- For each of these Long-Term Goals, list up to five positive Short-Term Goals (what you wan to be able to do within several days or several weeks, stated in positive terms).
- If you have listed more than one Short-Term Goal, rank order them two times:
- from the least difficult to the most difficult
- from your most important, highest priority to your lowest priority.
To understand the difference between a Long-term Goal and a Short-term Goal, consider this example. Imagine that you are thirty years old and have worked as a typist for the past six years. After much soul-searching you feel a strong need to become more independent in your life's work. You decide to establish this as your Long-term Goal: greater job independence. Now what?
Your next step is to create a short-term plan that will help move you toward independence. You ask yourself, "What can I do today, this week, or this month about that goal?" The answer to this question is your Short-term Goal: "This month I will investigate what kinds of jobs might give me greater independence." This Short-term Goal now gives you a concrete and specific set of tasks to accomplish in the immediate future. Once you set your Short-term Goal, you always have some positive tasks to direct your actions.
Let's say that after a month of exploring options, you take another step closer to your goal: "I think there is room in this city for a word-processing service. With my experience I know what it takes to provide quality typing to customers. I think I am capable of managing a small staff of typists. But I don't know much about business." You set your next Short-term Goal: "I'll take a 'small business' course at night this fall at the technical college." Now you have a distinct focus. You must select the best course, register, buy the materials, attend class each week, complete your homework assignments, and so forth.
It is far easier to motivate yourself when your goal is almost within reach. Small decisions can now seem important, because they influence your immediate-future goals. If you have difficulty applying yourself to your studies because owning your own business seems so far in the future, then set your Short-term Goal closer to your reach: "By the end of this course I want to be able to say that I applied myself every week to complete the assignments of that week. Therefore, I will start by finishing my paper due this Friday."
This is the process to use in overcoming panic. For instance, some people might have the positive goal of "looking forward to the adventures of life without fearing panic." You will reach that goal by setting dozens of small goals, one after the other. As you accomplish one Short-term Goal you will set your sights on the next.
Don't be in a rush to reach your Long-term Goal. By focusing too much of your attention on the distant future, you can feel demoralized and frustrated, as though you will never arrive at your destination. Instead, create images of your positive future, but work actively on accomplishing immediate tasks.
If you list more than one Short-term Goal, rank order them two times: first, from the least difficult to the most difficult, and second, from your most important, highest priority to your lowest priority.
At any point in your day, you should be able to remind yourself of your Short-term Goal and create some task that moves you along. Do this not as a way to evaluate your progress, to point out your failures or to criticize your weaknesses, but as a way to keep yourself motivated. Be careful of the Negative Observers, who are always just around the corner. The biggest troublemakers here are the Critical Observer and the Hopeless Observer.
Again, paradox comes into play as you set your Short-term Goals and work toward them. The paradox is this: you should set a concrete, specific immediate goal, with every intent to fulfill that goal. At the same time, it does not matter whether you actually reach your goal in the way you expected.
For instance, let's say your Long-term Goal is to comfortably shop in stores again. You have been taking a number of steps to prepare, such as practicing the Calming Breath a dozen times each day, spending quiet, meditative time for twenty minutes each day, and learning to give yourself Supportive Observer comments during stressful times. Now you decide to set a new Short-term Goal: "to walk around inside South Square Mall today, looking in store windows with a friend, for thirty minutes." Once you commit yourself to that Short-term Goal, you take as many steps toward that goal as you can manage. It is unimportant whether you accomplish that goal today. Your task is to set a Short-term Goal and move toward it to the best of your ability. And no further. Tomorrow you will simply review your learning from today and set a new Short-term Goal if needed.
We all deserve to feel a sense of pride and success. Don't rob yourself of those good feelings by labeling yourself as a failure when you don't accomplish a task. Do not define your personal success in terms of reaching your Short-term Goal. In conquering panic, you are successful any time you are actively moving toward your goal, regardless of whether you reach it.
Create short-term tasks
In this planning stage, the third step is to identify specific actions that will move you from your abilities today to the abilities needed to reach you goals. Practice this step now by picking one of your Short-term Goals. Think of and write down a list of related tasks, which gradually move you closer to accomplishing that Goal. The first item should be a low-risk experience that you can imagine accomplishing soon. Each successive item should include a little more risk-taking and should move you a little closer to your Goal.
Don't worry about creating the perfect schedule. Later, as you begin using this schedule, you will revise it based on your experience. Simply outline a stepwise approach to accomplishing your Goal. Here is an example.
Example:
SHORT-TERM TASKS - DRIVING
SHORT-TERM GOAL: Comfortably drive a two-mile loop on the roads around my house.
SHORT-TERM TASKS:
- Map out a two-mile loop on the roads around my house.
- With a supportive person driving, ride as a passenger on this loop, noticing all the opportunities to pull over to the side of the road or to turn off on a side road, all the gas stations, stores, driveways, and telephone booths that are accessible to me.
- Drive this loop during a non-rush-hour time with a supportive person as passenger.
- Drive this loop during a rush-hour time with a supportive person as passenger.
- Drive this loop during a non-rush-hour time with a supportive person driving another car directly behind me.
- Drive this loop during a non-rush-hour time with a supportive person driving another car several cars behind me.
- Repeat #5 during rush-hour.
- Repeat #6 during rush-hour.
- Drive alone, with my support person waiting to meet me at a stopping point half-way along the route. Then have my support person leave before me and wait for me at the end of the loop.
- Drive the entire loop alone while my support person waits at the finish.
- Drive the entire loop alone while my support person waits by a telephone at another location.
FUTURE SHORT-TERM GOALS: Repeat all these steps for different loops and for longer distances, until I can confidently drive any distance I desire.
In order to look forward to the adventures of your life without fearing panic, one short-term goal must be to tolerate mild to moderate symptoms of anxiety. If you can accept those symptoms arising on occasion, and if you can trust in your ability to manage them, then your fear of them will diminish.
Once you set this Short-term Goal of learning to tolerate symptoms, you can establish short-term tasks. Practicing the breathing and Calming Response exercises in this book is a good first start. During this same early stage of learning you can begin listening for your Negative Observer comments (worried, self-critical, or hopeless thoughts) . Once you discover how your thoughts consistently reinforce your sense of fear, you can begin to practice Supportive Observer comments or other disruptive techniques. In this way you slowly chip away at panic.
Example
SHORT-TERM TASKS - TOLERATING ANXIETY
SHORT-TERM GOAL: Learn to tolerate symptoms of anxiety
SHORT-TERM TASKS:
In the next five days, I will
- Practice breathing skills 10 times a day
- Listen for and write down Negative Observer comments
- Practice Negative Thought Stopping daily
- Practice Supportive Observer comments whenever anxious
Make Your Tasks Reachable
There is always a step that is within your reach. If you feel incapable of accomplishing any of your tasks, you must create smaller and smaller steps until you find one to which you can say, "I wonder if I can do that? It seems within my reach." For instance, you don't begin learning public speaking skills by placing yourself at the podium in front of a thousand people. You learn by talking into a tape recorder and then listening to your voice, by telling more stories to your friends during dinner conversations, or by imagining yourself comfortably addressing a small group of friends.
If you fear panicking while you drive, the thought of taking a cross-country trip might by overwhelming. What can you imagine doing? Can you sit in the driver's seat of a car, with the ignition off, parked safely in the driveway, while you practice your Calming Response skills? If so, can you start the engine, back the car to the end of the driveway, then return it to its parked position, even if you feel somewhat anxious? Can you do that ten times? Once you feel in control of that step, can you drive around one block, with a supportive friend as a passenger? If not, practice driving to the corner and back. If that is not yet within your reach, let your friend drive the car to the corner, then exchange places and drive back yourself.
HIERARCHY OF TASKS FOR SHORT-TERM GOAL
For each Short-term Goal:
- Create a list of related tasks that gradually move you closer to accomplishing your long-term goal.
- Review the list to insure that:
- the first item is the lowest-risk item on the list that you can imagine accomplishing soon, and
- each successive item includes a little more risk-taking and moves you a little closer to your goal.
Regardless of what you fear, there is always a step small enough for you to take toward overcoming that fear. Whenever you run into difficulty, simply back up to a smaller step. The size of your step can never be too small. As the Chinese philosopher Lao Tsu wrote in the sixth century BC, "A tree as great as a man's embrace springs from a small shoot; a terrace nine stories high begins with a pile of earth; a journey of a thousand miles starts under one's feet."
How to practice your skills
Home Study
The Don't Panic Self-Help Kit,
Section I: Practice Success Imagery
Tape 3B: Three-Minute Success Imagery
Now you are ready to begin working on the tasks you outlined above, while applying the knowledge and skills from all of these sections. The stages of this step are: preparing for practice, beginning practice, responding to worried thoughts, responding to uncomfortable physical sensations, and ending the practice.
As you begin your practice, remember to face tasks one at a time. Don't look back to your last practice unless it is to remind you of your skills and capabilities. And don't look ahead as a way to remind yourself how far you have to go. Continue to practice a specific task until you feel relatively comfortable (never wait until you are completely comfortable), then begin the next one. Don't measure your progress by how quickly you improve your skills. Measure your progress by how persistent you are in your determination to reach your Short-term and Long-term Goals. Shaping your positive attitude each day, and developing a consistent schedule for practice -- these two intentions will pay off with success.
Choosing a Short-term Goal
You will be practicing the Short-term Tasks listed under one or more Short-term Goals, so your first decision is to choose a beginning Short-term Goal. There are no rules for selecting the perfect Short-term Goal to work on; use your best judgment to pick one. You have rank ordered your Goals in two ways: how difficult they seem and how important a priority they are. Let those rankings help you make your decision. For instance, there may be a Goal that is moderately hard on your difficulty list but is a high priority. Your desire to accomplish that Goal may help motivate you to work on it now, even though there are easier items on the list.
You also can work on more than one Short-term Goal at a time. Perhaps you choose to focus both on the goal of driving comfortably to the mall and the goal of tolerating exercise that elevates your heart rate. You may have time in your week to practice driving skills every two days and practice cardiovascular workouts on the opposite days.
Preparing for practice
There is a great array of options for practicing Tasks. In the beginning weeks, I suggest that you follow a structure similar to the one I am presenting in this section. As you get more proficient at designing and implementing your practices, then feel free to take "short cuts" in the process. By the end, your practice can be as informal as this: "Hmm . . . I feel anxious about doing something like that. I think I'll try it!"
For instance, one of my clients is working construction in an office building. One day last month his co-worker reported that one of the elevators had been temporarily stuck between floors for a few minutes. Upon hearing that, Alan became anxious and worried about getting stuck himself. Within a few minutes he excused himself, walked to the bank of elevators and rode one to the top floor and back. He simply would not allow his fears to begin to take hold of him anymore.
Before practicing any Short-term Task that moves you closer to your Goals, consider each of these questions in detail. You will benefit from writing your answers down, making them concrete.
Planning Each Task
- What is my task?
- When will I do this?
- How long will I take?
- What worried thoughts do I have about this task?
- What self-critical thoughts do I have about accomplishing this task?
- What hopeless thoughts do I have about this task?
- What can I say (in place of those negative thoughts) to support myself during this task?
- How can I increase my sense of commitment while working on this task? (information about the setting or even, sense of options, willingness to take risks and reel uncomfortable, use of props such as a book or music, etc.)
- What support do I need from others?
Deciding how long to practice
Whenever possible, practice your task for 45 to 90 minutes at a time. It is true that shorter practices also will help your confidence, and some types of practices can only last a few minutes (such as looking people in the eye and smiling as you go through a reception line). However, from research we know that one of the most important purposes of Task practice is to develop habituation: during prolonged exposure to an anxiety-provoking situation, intense anxiety gradually decreases. As your anxiety diminishes, you can think more clearly. In the future, when these situations occur again, you will react with some anxiety, some distress, but not the terror that you once had.
So when you can, design your sessions for this 45- to 90-minute length, which promotes habituation as well as confidence. That may mean you will have to repeat the same behavior several times. Forty-five minutes will afford you many elevator rides. An hour's shopping may require a trip to the grocery store then a walk next door to the pharmacy. Ninety minutes of aerobic exercise can mean that you run in place 5 minutes, then spend the next 15 minutes calming yourself down if you got too scared, then another 5 minutes of aerobics and 10 minutes of calming yourself, and so forth, until the time is up. The definition of "practice" means anything that you do while still facing the anxiety-provoking situation. For instance, you might enter the grocery store and stay only 5 minutes, then have to leave because of your distress level. For the next 30 minutes you may need to sit in your car, practicing your breathing skills to calm down enough to re-enter the store. Then you enter the store for another ten minutes before finishing your practice. That equals 45 minutes of practice -- even though most of it was in the car -- because all of that time you were working.
Creating supportive statements
Study your answers to questions 4, 5 and 6, above. These Negative Observer statements will be the most likely ways you will sabotage your efforts in the practice. Use them to design your supportive statements (question 7). Write these positive statements down on a card to carry with you during practice.
Increasing you commitment
As you plan your practice, consider what you can do to support your commitment. Certainly reviewing the eight attitudes is a positive step, because they will remind you that taking risks is the smartest way to get stronger.
You may also feel safer and therefore more committed if you gather information about the setting or event. If you are attending a party, know what the appropriate attire will be. If you are driving a new route, check the map in advance or take the ride first as a passenger. If you are spending a night in an unfamiliar hotel, call ahead to learn about their facilities.
Bring along any "props" that can help you manage the situation. For instance, if you are practicing eating alone in a restaurant, you might carry a novel to read as you wait for your food. For a long drive, bring your favorite music or borrow a book-on-tape from the library.
Receiving support from others
Decide if you would like one or more support persons to assist you in the practice. If so, choose people who believe in your worth and respect your efforts to improve yourself. They don't have to have an intimate knowledge of anxiety problems; in fact, they might even be confused about the subject. They do need to be willing to follow instructions. Tell support people exactly how you would like them to help. What should they say to you before and during the practice? What should they do?
Visualizing success
In the Don't Panic Self-Help Kit you will learn about the many visualizations that can help you prepare for practice. After you review that section, include any relevant imagery practices into your preparations.
Here are three brief visualizations to work with during the few minutes just before you begin your Task practice. (For example, if you are about to enter the grocery store, practice one or both of these visualizations while in your car at the store parking lot.) Each of them takes about three minutes.
Three-Minute Success Imageries
- Successful Outcome. Close your eyes and see yourself after you have just finished your Task and it went perfectly, beyond your expectations. Don't concern yourself at all with how you reached your goal. Just enjoy the pleasure of possible success.
and/or
- Successful Task. Close your eyes and visualize yourself accomplishing your Task easily and without discomfort. Repeat that positive image a second time.
and/or
- Successful Skills.* Close your eyes and visualize yourself moving through your Task. Let yourself experience two or three episodes in which you have some typical discomfort. Then rehearse what coping skills you want to use to take care of yourself during that discomfort. Imagine those skills working successfully.
* Always practice this one before a Task.
Beginning the practice
Now you are ready to enter the troubling situation. Remind yourself of each of your supportive statements. Take a gentle, slow Calming Breath after saying each one, giving yourself time to believe it.
Enter the situation with the expectation of responding naturally and easily to all that you encounter. Forget about yourself and pay attention to what you are presently perceiving with your five senses: what you are seeing, hearing, touching, smelling, and maybe even what you are tasting.
Use any of your skills to manage your thoughts and your physical symptoms. Continue to encourage yourself and ask for any needed support from others.
If you begin worried thoughts or if physical symptoms begin to bother you, use the two approaches below.
Responding to worried thoughts
In Step 8, you will learn the skills of responding to your worries. Here we are applying these skills to worries you have during your Task practice. The guidelines are simple: notice your worried thoughts, choose to stop them, then apply skills that support your decision. Which of these skills or combination of skills you use will depend on your Task, the nature of your worries and what has helped in the past. Sometimes you will need to explore several options before coming up with the most successful combination.
RESPONDING TO WORRIES
NOTICE YOUR WORRIED THOUGHTS:
CHOOSE TO STOP THEM:s
- "These thoughts aren't helpful. I can let them go."
TAKE SUPPORTIVE ACTION: PRACTICE ANY OF THESE:
- Supportive statements
- Find something neutral or pleasant to do
- Negative thought stopping
- Postpone your worries
- Sing your worries
- Write your worries down
- Take 3 Calming Breaths
- Do Calming Counts
- Move and loosen whole body
- Turn attention elsewhere
- Leave the situation and go to a "safe" place
Responding to uncomfortable physical sensations
Again, like with your worries, the best approach to uncomfortable physical symptoms is a simple one. First, mentally "step back" and notice the sensations without making worried comments. Second, reassure yourself: "It's OK for these symptoms to exist right now. I can handle these feelings." Then, third, ask yourself: "What can I do to support myself right now?"
Choose among the supportive actions listed, based on the nature of your symptoms, the circumstance, and what has helped you in the past. Here are some examples.
- You can assure yourself that you can manage your task while experiencing these sensations. You then can turn your attention away from yourself and to the things around you. Involve yourself more actively in your surroundings (seek out a conversation or find something in your environment to study carefully) as a way to diminish your worried involvement in your body.
- You can use Calming Counts as a way to support your physical comfort.
- You can tell a supportive person about what you are feeling and what you want to do to take care of yourself. You can let that person support your efforts.
- You can leave the situation for a brief period as a way to increase your comfort and control, then return to continue your practice.
- You can leave the situation and not return at this time. As you continue to practice your skills, over time you will learn to remain in the scene.
As you study the chart below, you will notice how similar the actions are when your physical symptoms are your strongest concern. There is one primary difference. Can you see it?
RESPONDING TO PHYSICAL SYMPTOMS
NOTICE YOUR SYMPTOMS:
- "I'm feeling uncomfortable."
ACCEPT THEM:
- "That's okay. I can handle this."
TAKE SUPPORTIVE ACTION: PRACTICE ANY OF THESE:
- Natural Breathing
- Take 3 Calming Breaths
- Calming Counts
- Brief Muscle Relaxation
- Supportive Statements
- Paradoxically Increase Symptoms
- Move and Loosen Whole Body
- Find Something Neutral or Pleasant to Do
- Turn Attention Elsewhere
- Leave the Situation and Go to a "Safe" Place
As you can see, there is one distinct difference in how you respond to each of these problems. Once you notice your worried thoughts, you choose to stop them. You reject the negative messages they are giving to your mind and body. The actions you take support that decision. On the other hand, when you notice your physical symptoms, you choose to accept them. Resisting your symptoms will only increase your discomfort.
This decision -- to accept your symptoms before trying to modify them -- is a pivotal one. We have talked about it in several sections. Start to become curious about its value as you try it out during Task practice.
Ending the practice
Now is the time to support yourself for all your efforts. At the same time, review your practice session objectively. Assess what worked and what didn't. Use that information to plan your next practice.
Remember that you are successful every time you decide to practice, regardless of how long you are able to stay in that situation. This is not a test of your ability to stop all sensations of discomfort. Nor is this a test of your progress. This, and every other thing you do, is an opportunity to practice your ability to support yourself. The more you practice supporting every effort and attempt, the stronger you will become and the more willing you will be to practice.
So LISTEN for any harsh self-criticisms or discouraged thoughts after your practice. ("I still get anxious. What's wrong with me! I'll never get better.")
And REPLACE THEM with statements of support: "I'm working to change a lot of complex processes. I can't do it all at once. And I'm not trying to do it perfectly. One step at a time; I'm going to get there."
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Children feel stress long before they grow up. Many children have to cope with family conflict, divorce, constant changes in schools, neighborhoods and child care arrangements, peer pressure, and sometimes, even violence in their homes or communities.