Mastery of Anxiety and Panic - My Doctor Online

Mastery of Anxiety and Panic

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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

Introductions

YOUR NAME WHERE YOU GREW UP

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.


• 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.


• 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

Evolution of the Human Mind

• https://www.youtube.com/watch?v=kv6HkipQcfA

The Reacting Brain

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.

CTHE GOOD NEWS!

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…

C

TREATMENT FOR ANXIETY PROBLEMS IS

VERY SUCCESSFUL!

CTREATMENT

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-


https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-9780195311358-interactive-pdf-002.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

Agenda for Week 2

Homework Check-In

Stopping the Anxiety Cycle

Panic and Anxiety Myths

Homework

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?

Stopping the Anxiety Cycle

TRIGGERS THOUGHTS ACTIONS SENSATIONS

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

CFEARS VS FACTS

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:


• Panic Attack Records:• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-


• Progress Record (Optional):• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-






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


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



LAST?

HAVE ANY PATTERNS

EMERGED?


SENSATIONS?



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…

CDIAPHRAGMATIC

BREATHINGMichigan Medicine Diaphragmatic Breathing Video

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

Facts About Breathing

The most Important point about

hyperventilation is that it is NOT dangerous

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

CMEDITATION

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

Elements of

Meditation

Focused Attention

Relaxed Breathing

A Quiet Location

A Comfortable

Position

Types of Meditation

Guided

Mantras

Mindfulness

Qi Gong

Tai Chi

Yoga

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:




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


Practice Breathing Daily


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.


Examine Homework



LAST?

HAVE ANY PATTERNS

EMERGED?


SENSATIONS?



CBT Triangle

Thoughts

Behaviors Emotions

CBT Triangle

Thoughts

EmotionsSymptoms

People with panic fear:

PANIC PHYSICAL SYMPTOMS

SCARY THOUGHTS

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?

C

THOUGHTS BECOME LESS ANXIETY PROVOKING THE MORE THE PERSON FACES

THEM

Homework• Record Negative Thoughts


• Changing Your Odds Worksheet (Jumping to Conclusions)• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-


• Changing Your Perspective (Catastrophizing)• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-






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



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


Examine Homework



LAST?

HAVE ANY PATTERNS

EMERGED?


SENSATIONS?



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.

C

A PANIC ATTACK IS A REACTION – THERE IS ALWAYS

A TRIGGER OR A CAUSE

CWHY FACE THE

FEARS?

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

CC

THE GOAL IS TO BE LESS AFRAID OF

SYMPTOMS PRODUCED BY THE SYMPTOM EXERCISE

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

CCLET’S FACE

THOSE FEARS!

Homework• Symptom Assessment


• Facing Symptoms• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-





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


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



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.


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

CONTINUE TO FACE THE FEAR

DELIBERATELY REPEATEDLY INTENTIONALLY

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

CC

A PANIC ATTACK DOES NOT MEAN A RELAPSE OR THAT YOU HAVE LOST ALL THAT

YOU HAVE GAINED!

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


• Facing Agoraphobic Situations• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-


• Come Up with Your Practice Plan• https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195311358.001.0001/med-






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

Curriculum Acknowledgment: Original content: Matthew Wilhelm, PsyD, Union City Facility-KP, [email protected]• Barlow & Craske• PPT created by: S.Humphrey

Mastery of Anxiety and Panic - My Doctor Online

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