Mastery of Anxiety and Panic - My Doctor Online
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General Ground
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Dr. Katz
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Group Outline
Session 1: Psychoeducation
Session 2: Psychoeducation
Session 3: Breathe Retraining
Session 4: Thinking Skills
Session 5: Experiential Exposure
Session 6: Relapse Prevention
Agenda for Week 1Introductions
What this group treats
Symptoms of Panic and Anxiety
What Causes Anxiety?
The Science-y Stuff – Reacting Brain vs. Thinking Brain
The Anxiety Cycle
Homework
Is This Group for Me?
• Panic Disorder • Panic Disorder is a condition in which the person
suffers recurrent panic attacks. Panic attacks are sudden attacks that are not caused by a substance (like caffeine), medication, or by a medical condition (like high blood pressure). During the attack, the sufferer may experience sensations such as accelerated or irregular heartbeats, shortness of breath, dizziness, or a fear of losing control or “going crazy.” The sudden attack builds quickly (usually within 10 minutes) and is almost paralyzing in its severity. Persons begin to develop fear and anxiety about future panic attacks. When a diagnosis of panic disorder is given, the disorder can be considered one of two different types – panic disorder with or without agoraphobia.
Is This Group for Me?
• Panic Disorder without Agoraphobia• The person is plagued by panic attacks that occur
repeatedly and without warning. After these attacks, they worry for 1+ months about having more embarrassing attacks, and may change their behavior with regard to these attacks. For example, they may quit their job or stop exercising. Patients may also worry that they are going to lose control or appear insane to other people. Panic without agoraphobia has a less severe set of symptoms than panic disorder with agoraphobia. Patients without agoraphobia do not become housebound – they suffer panic attacks, but do not have significant interference in their level of function and are still able to accomplish their daily activities.
Is This Group for Me?
• Panic Disorder with Agoraphobia• People who suffer from this kind of panic disorder
may experience their agoraphobia in one of two ways. They may experience sudden, unexpected panic attacks that cause them to fear being in a place where help may not be available; or they may experience sudden panic attacks in specific, known situations, and fear those situations or places that may trigger panic. In either case, the fear of further panic attacks restricts the affected person’s activities. For example, people whose attacks are triggered by being in crowds may avoid shopping malls for fear that they will be in a crowd and have a panic attack. Or, a person may experience sudden, debilitating panic attacks without a particular trigger, and, as a result, they are afraid to go to the supermarket (or similar place) for fear that a panic attack could occur while there and no one could help.
What Triggers Anxiety?1. Genes2. Chemicals3. External Stress4. Self-Demands / Self – Talk5. Past Events• These triggers create a sense of threat or danger, which
activates your brain to react• This response is primitive (e.g. cave man ancestors & physical
threats)• Nowadays, our “dangers” and “threats” are not physical• Our alarms are VERY convincing, but aren’t perfect! There can
be false alarms
The Reacting Brain
• A Primitive Bodyguard.• Designed to protect us and is life saving.• Released adrenaline and causes an intense,
harmless, physical response.• Learns signs of danger easily and never forgets.• Can think situations, sensations, thoughts,
feelings are dangerous, even though they are harmless.
• Is not rational.
•Learns from experience.
The Reacting Brain
• Reacting brain causes adrenaline to be released, triggering fight-or-flight system, which causes physical sensations.
• These are physical, harmless, protective, and designed to save you.
• Causes your mind to be flooded with Thoughts of Fear and Danger.
• The reacting brain wants you to stop thinking of anything else and look for danger.
• When this is triggered and it misfires, there is no danger, but your mind is flooded with thoughts of fear and danger anyway because reacting brain does not know that it’s a false alarm.
The Reacting Brain
• You need to use your Thinking Brain to get the facts and override your primitive, bodyguard Reacting Brain.
• If you don’t know that this can be a false alarm, you take fear actions based on believing the fear thoughts:• Escape (leave, distract self, take an anti-anxiety pill)• Avoid (places, activities, situations, sensations,
thoughts…)• Look for Danger• Fight the anxiety response because it feels scary
The Anxiety Cycle
Fear Actions = Fight-or-Flight actions
These make fight-or-flight response more
likely
They convince the Reacting Brain even
more that what it fears must, indeed, be
REALLY DANGEROUS
Otherwise, you wouldn’t be running or fighting it or staying on
the lookout for it
Then the Reacting Brain tries to protect
you by setting off false alarms more often
The goal is to break this vicious cycle
Physical Sensations of AnxietyThe fight-or-flight response is a healthy, intense, harmless, life-saving physical response
It is designed to save your life when the Reacting Brain thinks you are threatened
It is triggered automatically and can be triggered when there’s no danger
It can be triggered by fears or without you knowing why
It is always trying to protect you even when it misfires and goes off when you don’t need it
Figh
t or F
light
Racing Thoughts
Dry Mouth
Heart beats faster
Breathing becomes quicker or more shallow
Nausea & Butterflies
Hands get cold
Dizzy or Lightheaded
Changes to vision
Adrenal glands release adrenaline
Bladder Urgency
Palms become sweaty
Muscles Tense
Adrenal glands release adrenalineThe adrenaline quickly signals other parts of the body to respond to danger
Racing ThoughtsQuicker thinking helps us to evaluate danger and make rapid decisions and making it very difficult to concentrate on anything other than the danger
Heart beats fasterA faster heartbeat feeds more blood to the major muscles, enhancing ability to fight or run away
Nausea & ButterfliesDigestion shuts down as blood is diverted away from the digestive system. Can cause a feeling of nausea or “butterflies.”
Muscles TenseMuscles tense to be ready for action. Muscles may also shake or tremble if we remain still.Fi
ght o
r Flig
ht
Figh
t or F
light
Dry MouthDigestion starts in the mouth
Bladder UrgencyMuscles in the bladder may relax in an effort to drop excess weight so we can be lighter and faster
Hands get coldBlood vessels in the hands constrict to direct blood flow to major muscles
Changes to visionVision becomes more acute to pay attention to danger. You may notice tunnel vision or sharper vision
Breathing becomes quicker or more shallowQuicker breathing takes in more oxygen to power the muscles, making the body more able to fight or run away
Palms become sweatyWhen in danger, the body sweats to keep cool. A cool machine is an efficient machine, so sweating makes it more likely to survive a dangerous event.
The Good News!We also have a Thinking Brain!
Wise and Logical
We can use it to override the Reacting Brain’s reaction
Reprograms the Reacting Brain, and…
Treatment Options
• Cognitive-Behavior Therapy• Very useful in treating anxiety disorders• The cognitive part helps people change the thinking
patterns that support their fears• The behavioral part helps people change the way
they react to anxiety-provoking situations• Can be done individually or in a group of people
with similar problems
• Medication• Can be combined w/ psychotherapy• This is the best approach for many people• Medication will not cure anxiety disorders, but can
help keep them under control while receiving psychotherapy
• Prescribed by MDs• Antidepressants and Anti-Anxiety drugs
Book Recommendation• 10 Simple Solutions to Panic; How to Overcome Panic Attacks, Calm Physical Symptoms, and Reclaim Your Life • by Martin M. Antony, PhD and Randi E. McCabe, PhD
Homework• Daily Mood Records:
• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-9780195311358-interactive-pdf-002.pdf
• Panic Attack Records:• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-
9780195311358-interactive-pdf-001.pdf
• Progress Record (Optional):• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-
9780195311358-interactive-pdf-003.pdf
At Home Supplemental Read
Chapters 1-4Mastery of Your
Anxiety and Panic
Workbook 4th
EditionBarlow and
Craske
Watch
Evolution of the human mind
video by Russ Harris
https://www.youtube.com/watch?v=kv6HkipQ
cfA
Do
Daily Mood Records
Panic Attack Records
Examine Homework
WHAT WERE YOUR TRIGGERS?
HOW LONG DID A PANIC ATTACK
LAST?
HAVE ANY PATTERNS
EMERGED?
WHAT WERE YOUR PHYSICAL
SENSATIONS?
WHAT WERE YOUR SCARY THOUGHTS?
WHAT WERE YOUR BEHAVIORS?
Triggers
Reduce Triggers
A healthy, functioning nervous system means when anxiety triggers are hit, you are going to have anxiety
BUT! Reactions can be changed so that anxiety is just unpleasant, not scary or disruptive
Thoughts
Get all the facts about all of your fears
Compare what your fear thoughts are telling you vs. what the real facts are
If fear thoughts and facts are aligned, then the anxiety is a true alarm doing its job
If your fear thoughts and facts are not aligned, you have an anxiety problem
Actions
Act on the facts, not on your fears
If it is a false alarm, do the opposite of what the anxiety tells you
Deliberately and repeatedly confront your fears to show the Reacting Brain that it is safe
Remember: The Reacting Brain only learns from experience and learns safety S L O W L Y
Anxiety is a good sign that you’re giving the Reacting Brain a chance to relearn
Sensations
Use slow, deep breathing or relaxation to tolerate unpleasantness and anxiety sensations
These sensations won’t hurt you
Don’t use breathing to desperately try to stop sensations because you are afraid of them
The Reacting Brain will pick up on your fear, decide you are in danger, and keep reacting
Fear
Anxiety means there is danger
Not necessarily. The anxiety response can be triggered in your brain even when there is no real danger
Fact
Fear
Anxiety sensations mean something is physically wrong
No. Anxiety sensations only mean your fight-or-flight response got triggered
Fact
Fear
Anxiety will get worse or occur more and more often
FactNo. Your actions and responses make anxiety worse or better
Fear
An anxiety attack can continue forever and never stop
FactAn anxiety attack can’t continue forever because you run out of adrenaline and your body starts activating the peaceful side of the nervous system.
Fear
Anxiety can make people go crazy
FactAnxiety is a natural reaction. It causes problems when it’s triggered too often or when you react by doing things that make it worse. Being crazy is a different illness entirely and is not related to anxiety at all.
Fear
Everyone can tell I’m anxious and will think I’m weak, incompetent, or crazy
FactMost people, even in anxiety groups, can’t tell when others are anxious. People who do know that another person is anxious are usually sympathetic.
Fear
Too much anxiety will make me completely non-functional, incoherent, paralyzed
FactThe purpose of anxiety is to prepare you to take action to save your life when in danger. Mother nature wouldn’t design a danger response that makes you non-functional
Fear
I’ll go out of control or do something crazy
FactSee the information above. You may feel revved up because you’re prepared to fight or flee.
Fear
If I feel faint or dizzy, I’m likely to pass out
FactRemember, you are being prepared to run or fight, not pass out. The changes in breathing, vision, and blood flow make you feel dizzy but are the opposite of what has to happen for you to faint
Fear
Anxiety can make me stop breathing, suffocate, choke to death, or be unable to swallow
FactYou may feel this way because of muscles tensing, breathing changes, and dry mouth, but you won’t suffocate or die
Fear
The anxiety reaction will damage my body. It’s causing physical harm.
FactThis is a built-in, natural, life-saving response designed to protect you, not harm you. However, chronic tension and worry may cause health problems. Talk to your doctor if you have a medical illness (high blood pressure or past heart attack)
Homework• Daily Mood Records:
• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-9780195311358-interactive-pdf-002.pdf
• Panic Attack Records:• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-
9780195311358-interactive-pdf-001.pdf
• Progress Record (Optional):• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-
9780195311358-interactive-pdf-003.pdf
At Home Supplemental Read
Chapter 9 &11Mastery of Your
Anxiety and Panic
Workbook 4th
EditionBarlow and
Craske
Watch
Michigan Medicine
Diaphragmatic Breathing
https://www.youtube.com/watch?v=UB3tSaiEb
NY
Do
Daily Mood Records
Panic Attack Records
Agenda for Week 3Review of Last Week’s Material
Homework Check In and Questions
Breathing: Too Much or Not Enough?
Breath Retraining
Meditation Benefits & Skills
Homework
Take-Home Messages
from Weeks 1&2
Panic symptoms are harmless
Panic cannot last forever
With anxiety, the reactive brain may be telling our bodies to fight or flee but we can do better by using our logical brain
Thoughts, sensations, and behaviors are all connected; We are looking to break the negative cycle
This stuff may feel “odd” at first, but allow yourself to trust the principles and ideas even if they feel “wrong” or “unnatural” or “uncomfortable”
Examine Homework
WHAT WERE YOUR TRIGGERS?
HOW LONG DID A PANIC ATTACK
LAST?
HAVE ANY PATTERNS
EMERGED?
WHAT WERE YOUR PHYSICAL
SENSATIONS?
WHAT WERE YOUR SCARY THOUGHTS?
WHAT WERE YOUR BEHAVIORS?
Breathing: Too much or Not Enough?
• 60% who panic show signs of overbreathing or hyperventilation
• Overbreathing naturally brings O2 to the muscles• Hyperventilation may produce an initial physical
sensation that frightens the person and causes panic• Fear and panic may cause a person to hyperventilate• May be a reaction to feeling like one is suffocating• Symptoms of hyperventilation include dizziness,
lightheadedness, shortness of breath, blurred vision, cold sweats, hot flashes or cold chills, feelings of faintness, rapid heart rate, tightness or pain in chest, and slurred speech
• Hyperventilating is a LOT OF WORK! May cause feelings of exhaustion or tiredness
• Symptoms are intense, but not dangerous• Can become a habit – one may become more prone
to overbreathing
Is Overbreathing
Part of Your Panic?
• In general, do you feel short of breath, as if not getting enough air?
• Sometimes feel you are suffocating?• Experience chest pain or pressure in chest?• Experience tingling, prickling, or numbness?• Frequently yawn or take big gulps of air?• When you are frightened, do you hold your
breath or breathe shallowly and quickly?• If so, you may need breath retraining…
Facts About BreathingThe balance of O2
and CO2 is very important and
maintained chiefly through rate and
depth of breathing
At rest, the appropriate rate of
breathing is typically 10-14
breaths per minute
Hyperventilation is breathing at a rate and depth that are
too much for the body’s needs
Exercise requires more O2 and it is
natural to breathe heavier
Fear can cause a person to increase breathing b/c the
muscles need more oxygen in order to
fight or flee
If the extra O2 is not used up at the rate
it is brought in, a state of
hyperventilation occurs
During hyperventilation a
decrease in carbon dioxide is responsible
for most physical effects
Narrowing of certain blood
vessels are responsible for dizziness and
weakness
Less blood flow and less oxygen gets to
the brain and certain parts of the
body
4X4X4X4 Breathing
As you breathe in
count up to 4
As you breathe out
count up to 4
Practice for 4 minutes, 4
times per day
Important to practice
multiple times per day, not
just when you are panicked
Reminder Prompts
Use technology: Cell phones,
alarms, calendar on
your computer
Red lights During commercials
Before/After eating
When changing
rooms
When brushing
teeth
When washing dishes
Meditation
Meditation brings mindful awareness to the present moment.
When we are present in the NOW, we are not ruminating about the past or worrying about the future
Originally a spiritual practice, mediation practices are often not associated with a particular belief system
Can be practiced anytime, anywhere
Clinically shown to reduce anxiety, tension, worry and restore a sense of calm
Understanding Meditation
• Meditation is a mind-body complementary medicine
• Produces a deep state of relaxation and a tranquil mind
• During meditation, you focus your attention and eliminate the stream of jumbled thoughts that may be crowding your mind and causing stress
• Produces enhanced emotional and physical well-being
• Benefits continue when meditation session ends• Can help carry you more calmly through your
day• Can be formal or informal
Meditation and Well-
Being
• Meditations clears away the information overload that builds up every day
• Benefits include:• Gaining a new perspective on stressful situations• Building skills to manage your stress• Increased self-awareness• Focusing on the present• Reducing negative emotions
• Many medical illnesses are worsened by stress, scientific evidence shows that meditation improves:• Allergies• Asthma• Binge eating• Fatigue• Heart Disease• High blood pressure• Pain
Everyday Meditation
• Breathe deeply• Scan your body• Repeat a mantra• Walking meditation• Engage in prayer• Read or listen and take time to reflect• Focus your love or gratitude
Building Meditation
Skills
• Don’t judge your meditation skills• Don’t judge your meditation skills• It is COMMON and EXPECTED that your mind
will wander, no matter how long you’ve been practicing
• When your mind wanders, calmly and gently return to the object, sensation, or movement you’re focusing on
• Experiment with different types of meditation until you find what works for you and what you like
• There is no right or wrong way to meditate!• Don’t judge your meditation skills
Homework• Breathing Skills Record:
• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-9780195311358-interactive-pdf-006.pdf
At Home Supplemental Read
Chapter 6 & 7Mastery of Your
Anxiety and Panic
Workbook 4th
EditionBarlow and
Craske
Listen
Cognitive Distortions
https://www.youtube.com/watch?v=WRGV8TK
XNl0
Do
Daily Mood Records
Panic Attack Records
Practice Breathing Daily
Agenda for Week 4Review of Last Week’s Material
Homework Check In and Questions
Thinking Skills: Cognitive Triangle
Labeling Stinkin’ Thinkin’
Examining the Evidence
Homework
Take Home Messages
from Weeks 1- 3
Panic symptoms are harmless & cannot last forever. Our logical brain can overcome out primitive brain with practice.
Breath retraining and meditation can help us overcome the physical, psychological, and emotional symptoms of anxiety and panic
Practice makes perfect! The more we practice breathing techniques, the more available the are to us under stress.
Meditation can be formal or informal. Either is effective. Experimentation will help you find what works best for you.
This stuff may feel “odd” at first, but allow yourself to trust the principles and ideas even if they feel “wrong” or “unnatural” or “uncomfortable”
Examine Homework
WHAT WERE YOUR TRIGGERS?
HOW LONG DID A PANIC ATTACK
LAST?
HAVE ANY PATTERNS
EMERGED?
WHAT WERE YOUR PHYSICAL
SENSATIONS?
WHAT WERE YOUR SCARY THOUGHTS?
WHAT WERE YOUR BEHAVIORS?
How does this play out?
• Emotions are influenced by thoughts• Negative emotions cause more negative
thoughts• Feeling afraid increases the likelihood of
having scary thoughts• Having scary thoughts in the midst of panic
does not mean that the scary thoughts are true
• Anxiety and Panic produce scary thoughts
How does this play out?
• Some thoughts are so automatic that the person does not know what he/she is thinking (it becomes a habit)• For example: when you are driving your car you have
many automatic thoughts: foot on break, look in mirror, foot on gas, turn wheel slightly
• Panic attacks that seem to occur from out of the blue may be connected with scary thoughts that a person does not even know he/she has
• Sometimes people look for the reasons they are panicking. They may look for triggers or things in the environment. When they cannot figure it out, the attentions turn inward… “Something must be wrong with me. I must be going crazy.”
Stinkin’ Thinkin’•The two common mistakes that people make when they panic are:• Jumping to Conclusions about negative events• Also known as overestimating the likelihood
that something with happen, or confusing possible with likely
• Blowing things out of proportion• Also known as overestimating the severity of
consequences and catastrophizing
Examining the Evidence
•A person can develop more realistic beliefs by considering all of the evidence• What are the real chances of this happening?
• Has this ever happened before?• What is the evidence that it will or will not happen?
•Face the Fear with Facts!• Show the reacting brain that panic is tolerable and one is not going to die or go crazy.
Blowing Things out of Proportion
• Includes thoughts that situations are insufferable or catastrophic, when in actuality, they are not• Face whatever is frightening• The worst is not as bad as the person first thought
• The worst probably won’t happen• Face the Fear with Facts!
• Show the reacting brain that panic is tolerable and one is not going to die or go crazy
• If one keeps running away, avoiding, or distracting, the reacting brain thinks there is real danger
Facing the Fear
Must switch fears from: “How bad it would be if…” to “ways of dealing
with…”
Everything is manageable… you will survive
Brainstorming ways of reacting to
negative events is much more helpful than thinking only
about how horrible the event might be
How would cope if it DID happen?
Homework• Record Negative Thoughts
• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-9780195311358-interactive-pdf-012.pdf
• Changing Your Odds Worksheet (Jumping to Conclusions)• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-
9780195311358-interactive-pdf-013.pdf
• Changing Your Perspective (Catastrophizing)• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-
9780195311358-interactive-pdf-014.pdf
At Home Supplemental Read
Chapter 10Mastery of Your
Anxiety and Panic
Workbook 4th
EditionBarlow and
Craske
Continue
Daily Mood Records,
Panic Attack Records,Practice
Breathing Daily
Do
Record Negative Thoughts
Changing Your Odds/Perspective
for Jumping to Conclusions and Catastrophizing
Thoughts
Agenda for Week 5
Review of Last Week’s Material
Homework, Check In, and Questions
Facing the Fear
Homework
Take-Home Messages
from Weeks 1- 4
Panic symptoms are harmless & cannot last forever. Our logical brain can overcome out primitive brain with practice.
Breath retraining and meditation can help us overcome the physical, psychological, and emotional symptoms of anxiety and panic
Each time a scary thought comes to mind, you need to repeat these steps: (1) look at the evidence, (2) face the worst, (3) put things back in perspective, (4) repeat
Thoughts are guesses or assumptions
This stuff may feel “odd” at first, but allow yourself to trust the principles and ideas even if they feel “wrong” or “unnatural” or “uncomfortable”
Examine Homework
WHAT WERE YOUR TRIGGERS?
HOW LONG DID A PANIC ATTACK
LAST?
HAVE ANY PATTERNS
EMERGED?
WHAT WERE YOUR PHYSICAL
SENSATIONS?
WHAT WERE YOUR SCARY THOUGHTS?
WHAT WERE YOUR BEHAVIORS?
C
SCARY THOUGHTS MAY REAPPEAR DESPITE SUCCESS AT CHALLENGING THEM OR EXAMINING THE EVIDENCE.
THIS DOES NOT MEAN FAILURE.
Thoughts are Guesses or
Assumptions
•Testing a scary thought means discovering a scary thought about an upcoming event and then comparing it to the actual outcome of the event.
Physical Sensations
• Everyone has unusual and unpredictable physical sensations at times, for reasons that are natural and harmless (temperature, hormones, hunger, energy, thirst)
• WHAT A PERSON THINKS ABOUT THESE SENSATIONS IN THE KEY
• You may interpret these changes as harmful, then you may start to notice normal symptoms that usually go unnoticed… Then.. You… may… PANIC!!!
• Once you learn not to fear those physical sensations, you will NOTICE fewer of them and will not panic because of them.
Fear of physical sensations is central to panic disorder
Learning to manage the fear is key to controlling panic
Identify physical sensations that still remain scary
Repeat exercises that produce scary symptoms enough times so that you are no longer afraid
Bring on scary bodily sensations long enough for you to learn something new – specifically, that you are safe and the symptoms
are not harmful
Fear of physical sensations is
central to panic disorder
Learning to manage the fear is key to controlling
panic
Identify physical sensations that
still remain scary
Repeat exercises that produce scary symptoms enough times so that you
are no longer afraid
Bring on scary bodily sensations long enough for
you to learn something new –specifically, that you are safe and the symptoms are
not harmful
In achieving this goal, you are:
GatheringGathering more evidence that these symptoms are harmless
Practicing Practicing your coping skills
GainingGaining confidence in your ability to tolerate these types of symptoms
Homework• Symptom Assessment
• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-9780195311358-interactive-pdf-017.pdf
• Facing Symptoms• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-
9780195311358-interactive-pdf-018.pdf
At Home Supplemental Read
Chapter 5&8 Mastery of Your
Anxiety and Panic
Workbook 4th
EditionBarlow and
Craske
Continue
Daily Mood Records,
Panic Attack Records,Practice
Breathing Daily
Do
Symptom Assessment
Facing Symptoms 2-3x
Agenda for Week 6Review of Last Week’s Material
Homework, Check In, and Questions
Progress So Far
Maintaining Progress
Some Thoughts on Self-Care
Homework?
Next Steps
Take-Home Messages
from Weeks 1- 5
Panic symptoms are harmless & cannot last forever. Our logical brain can overcome out primitive brain with practice.
Breath retraining and meditation can help us overcome the physical, psychological, and emotional symptoms of anxiety and panic
Each time a scary thought comes to mind, you need to repeat the steps: 1) looking at the evidence, 2) facing the worst, 3) put things back in perspective, 4) repeat
Facing our fears is the only way to retrain our primitive brain to stop overreacting to sensations, thoughts, feelings, etc.
This stuff may feel “odd” at first, but allow yourself to trust the principles and ideas even if they feel “wrong” or “unnatural” or “uncomfortable”
What if I didn’t make much
progress?
You may need more time for improvement
You may not have been ready to do the program
You may need to put forth a little more effort and more regular practice
You may need to explore the principles of the program so that you can understand them better
Maintaining Progress
When you notice hesitation for reasons of fear, that is a sign for you to plunge ahead and do it!
Keep track of your mood at least once a month
The 1st six months after group, revisit the material at least ONCE a week
After those 6 months, review the material once a month
After a year, once every few months
Remember: your efforts should be at not fearing physical symptoms, not at preventing them
Dealing with High Risk Times
• As you approach stressful events, remind yourself to be on extra guard for tendencies to mistakenly think that physical symptoms are harmful
• If you do panic, remind yourself of the reasons that panic is more likely to happen under stressful conditions
• Make an action plan for such times• Panic may be brought on by conditions that
strongly remind you of past panic attacks• In this case, a panic attack does not
represent a relapse, but rather an old habit
Book Recommendation• 10 Simple Solutions to Panic; How to Overcome Panic Attacks, Calm Physical Symptoms, and Reclaim Your Life • by Martin M. Antony, PhD and Randi E. McCabe, PhD
A Few Notes on Self-Care
• Maintain healthy eating habits• Monitor sugar and caffeine intake
• Adequate Rest• Get restful sleep each night and take additional
time for relaxation through planned pleasant activities
• Exercise• Discharge tensions and increase energy levels
through medically appropriate exercise on a regular basis
• Set Realistic Goals• Identify what it is you want to do and the specific
steps and support you need to get you there• Communication
• Use assertive whole messages to express yourself and learn to say “No.”
• Support• Surround yourself with persons who are encouraging,
inspirational, and stimulating.
A Few Notes on Self-Care
• Compassion• Respond compassionately toward yourself and others.
Use affirmations frequently.• Stay aware of your thoughts
• Decide which thoughts you will attend to, and which you will not attend to.
• This is the critical role that affects moods, behaviors, and health.
• Positive Attitude• “Believe your life is worth living, and your belief will help
create the fact. Laugh. Have fun.”• Pleasant Activities
• Don’t wait for them to just happen, Plan them!• Practice Mindfulness
• Encourage living in each moment, even painful ones, as fully as possible
• Practice Relaxation• Deep breathing, guided imagery, body scan• Practice when you are relaxed, and use it when you are
stressed
Homework• Agoraphobic Situations Hierarchy
• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-9780195311358-interactive-pdf-007.pdf
• Facing Agoraphobic Situations• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-
9780195311358-interactive-pdf-015.pdf
• Come Up with Your Practice Plan• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-
9780195311358-interactive-pdf-021.pdf
At Home Supplemental Read
Chapter 12 Mastery of Your
Anxiety and Panic
Workbook 4th
EditionBarlow and
Craske
Watch
S
Something fun of your
own choosing!
Do
Practice PlanPlan to do something
FUN/Pleasant every single day
Thank You for Attending!• Next Steps:
• Check in with your regular provider• Check out kp.org/classes• Download and USE Calm and/or KP
My Strength Apps• Kp.org/self-care
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