Anxiety is the body’s natural response to a perceived threat. It is a usual to feel anxious from time to time, and a certain amount of anxiety helps us to feel alert and focused. Anxiety is often described as a fight or flight response from the body, when our bodies are physiologically preparing us to deal with a perceived threat. Anxiety is part of our natural survival system, used to predict danger ahead of time rather than finding ourselves unexpectedly at risk. 

When anxiety is triggered, we can constantly look for danger, becoming hyper-alert to any perceived threats, thoughts can race, emotions can feel overwhelming, and our bodies can tense and increase our heart rates. Although this response to threat can be helpful, constantly feeling anxious can prevent us from living our lives the way we want to, cycles of anxiety can be difficult to break and reinforce or exacerbate further anxiety.

This course aims to help the user understand how to learn more about their anxiety and the thought cycles that can occur when experiencing anxiety, and to learn some simple skills or techniques to manage anxiety and break these cycles. There are different approaches to anxiety, medication can be beneficial to some, and you should consider speaking to a health professional about the options open to you, including medication or talking therapy. 

Below is an example of how anxiety can become a cycle, reinforcing itself and leaving the person experiencing anxiety feeling ‘stuck’. We will explore these different stages and the skills that can help at each stage.


1.	Negative thoughts - I am useless/bad, something bad will happen
2.	Negative feelings - Sadness, Anger, Fear, Panic, Worry
3. Bodily Sensations - Tiredness, Racing Pulse, Sweating, Light Headedness
4. Behavioural Adjustments - Social Isolation and Avoidance
Reinforcing 1. and starting cycle again.

Although difficult, it is possible to break this cycle by training ourselves to react differently at each stage of this cycle. Becoming more aware of your own cycle at each of these stages can help you to be more objective and break the pattern. This cycle can often be started by a trigger, usually to something we care about, like our health, relationships, family safety etc. This can then lead to negative thoughts, often about ourselves or about the situation. Negative thoughts can easily become negative feelings or emotions, which can cause physical symptoms and sensations in the body, telling us we feel anxious. To try to cope with the anxiety we experience, we tend to adjust our behaviour to avoid situations that we know will be challenging. Although this can be helpful in the short term, these behavioural adjustments tend to prolong and increase anxiety in the long term, leading back to further negative thoughts. 

Avoidance can prevent us from learning that some of our fears may not be as bad as we are expecting, they can reinforce that we wouldn’t have been able to cope if we did go into the anxiety provoking situation, and they deny us the experience of feeling anxious, managing a situation, and then returning to a normal state unharmed by the anxiety or the situation. 

There are skills that can be learned to reduce the impact of anxiety on each stage of the above cycle, this course will present different options that have been proven to be successful with anxiety sufferers. It is important to remember that they are skills, like any other skill in life they need practice to become effective with them. You should not expect to be able to pick up a musical instrument and play beautifully the first time you try; it takes practice and dedication to master any skill. Whenever we try to learn new skills, or retain new information, this can be difficult if we are feeling anxious or distracted, so it will be beneficial to practice anxiety-management skills when you are not anxious, even if that sounds counter-intuitive. It can be difficult to control your thoughts when feeling anxious, so practising techniques and ingraining them will help you to implement them when you have reduced cognitive ability to stop and think.

Try to consider your own experience of anxiety and which stage or stages of the cycle are particularly difficult for you. Maybe negative thoughts keep you awake at night, or perhaps your anxiety causes you to isolate yourself from others? Our moods and emotions are closely linked with anxiety – does your anxiety make you feel sad, angry, or depressed? Maybe your experience of anxiety causes particularly difficult physical sensations and problems in your body? 

Identifying and exploring your experiences at different stages of the cycle can help you to identify which areas specific skills that will be covered later can help with, as well as identifying in what way you can expect to benefit from them when you develop an increased skill level in using them.

It will be beneficial to approach these skills with an open mind, some may feel unnatural or awkward, some may not benefit you, although all of them are research and evidence based. They can help to remove difficult thoughts or feelings completely, to begin with a more reasonable expectation is that they will allow you to feel calmer whilst waiting for these difficult thoughts or feelings to pass. Reducing the fear and power anxiety holds can limit its effect, when you can develop a plan of what to do and how to manage when feeling anxious, you can regain some control over the situation and of your responses and experiences. 


The Cycle of Anxiety

Negative thoughts

Managing our thoughts can help us to break the anxiety cycle by becoming less caught up in our own train of thoughts, and then behaving and reacting in a measured way. 


There are many benefits of **journalling** – writing about how we are feeling, what we are thinking, about something pleasant from our pasts, or where we want to go in the future. Journalling is a way of allowing our minds to express and release thoughts and feelings, it can help to make sense of these thoughts, and to distance ourselves from these thoughts instead of carrying them around. It can help you to feel empowered, picking up on patterns in your thoughts, and increasing self-awareness. Try just emptying your thoughts onto a page, or Google journalling if you have difficulty in getting started. 



Mindfulness skills can help to regain control of negative thoughts, with the aim of focusing us on our senses in the present, to release worries about the future and negative thoughts about the past. There are mindfulness activities such as going on a walk in the woods, but there are also specific techniques we can learn to practice and maximise the benefit from these methods.

The 54321-mindfulness technique is simple, yet powerful. 

First, take a moment to become mindful of your breath. Just a few deep breaths invite your body back into the moment, slowing everything down. Then, become aware of your environment.
Look For 5 Things You Can See: Notice the wood grain on the desk in front of you. Or the precise shape of your fingernails. Become aware of the glossy green of the plant in the corner. Take your time to really look and acknowledge what you see.

Become Aware Of 4 Things You Can Touch: The satisfyingly rough texture of the car seat. Your cotton shirt against your neck. If you like, spend a moment literally touching these things. Maybe notice the sensation of gravity itself, or the floor beneath you.

Acknowledge 3 Things You Can Hear: Don’t judge, just hear. The distant traffic. The voices in the next room. As well as the space between sounds.

Notice 2 Things You Can Smell: If at first you don’t feel like you can smell anything, simply try to sense the subtle fragrance of the air around you, or of your own skin.

Become Aware Of 1 Thing You Can Taste: The lingering suggestion of coffee on your tongue, maybe?

Repeat this process as many times as necessary. Take your time and notice how you feel afterward. You can also settle down and browse grounding meditations for anxiety relief including guided 54321 practices.





Thoughts will pass. Trying to stop thinking about something can reinforce it, try to remember that thoughts (especially opinions about ourselves) may or may not be true, they are not something that has to be acted upon, they can be allowed to arrive and leave on their own accord, and are not something that can harm us. Regardless, they will pass, accepting that negative thoughts will pass can remove some of their power. 



Challenge your thoughts, do not accept them as truth:

Does this thought help me to: 
- Take effective action? 
- Be the person I want to be? 
- Build the relationships I’d like to have? 

Consider:
- What would I get from buying into it? 
- Is this an old thought, have I heard it before? 
- ‘If I let this thought guide my actions, which direction will it take me? Toward valued living, or struggle and suffering?’ 

Label the thought:
Place these before the thought to get some distance from it. 
“I’m having the thought that…” 
“I’m noticing that I’m having the thought that….” 
“My Mind is saying that….”


Negative Thoughts

Negative emotions

When we feel emotionally overwhelmed, the limbic system in our brain takes over and the rational or thinking part of our brain is not used. This can make it difficult to be objective, to think clearly, and to limit the intensity or duration of the emotional response.
 
The following exercises and skills can help to increase our tolerance to negative emotions, soothe our own distress or help us to feel steady and stable when confronted with overwhelming emotions. 


Self-soothing:
Many people are often good friends to others, able to respond to their distress with empathy and kindness, although it can be much harder to show tolerance and kindness to ourselves when feeling emotional distress. Instead of judging our own emotional responses, or becoming frustrated, try some of these self-soothing exercises with the aim of providing a positive sensory experience for each of your five senses, they are examples and not an exhaustive list, use your imagination to come up with a list for yourself or add to these:

Sight:
Look at the stars at night
Look at pictures you like in a book, on your phone or on the internet
Look at a beautiful flower or plant
Make one space in a room pleasing to look at
Go people-watching or window-shopping.
Go to a museum or gallery with beautiful art
Watch a sunrise or sunset
Take a walk in a scenic area of town or a park

Hearing:
Listen to soothing or invigorating music
Listen to sounds of nature – wind, birds, rain, waves
Pay attention to the sounds of the city, people, cars
Listen to the radio

Smell:
Use your favourite soap or cologne
Burn incense or light a scented candle
Open a pack of coffee and smell the aroma
Make some cookies or bake some bread
Go for a walk and pay attention to anything you can smell around you, in the city or in a park or wood

Taste:
Eat some of your favourite foods
Drink a soothing drink, like a hot chocolate
Chew some gum
Treat yourself to a sweet or some candy
Eat something mindfully, carefully think about the flavour and the texture

Touch:
Have a hot bath or a cold shower
Pet your dog or cat
Have a massage, soak your feet
Put a cold compress on your forehead
Wrap up in a blanket
Try holding and feeling natural objects like wood, leather or stone, think about how they feel and notice the details of them 






Anchoring:
Consider the analogy of yourself as a ship at sea. Life can present different conditions, sometimes smooth sailing but other days we can be faced with stormy conditions that blow and drag us around in the turbulent waters of our emotions. The anchoring skill enables us to drop an anchor through these waters and access the calm depths of the ocean. If you can add this skill to your daily routine for 10 minutes, the regular practice can enable you to develop an automatic response during the strongest emotional conditions. 

1. Stand, sit or lie down (whichever you prefer), with back straight but not stiff, shoulders relaxed, and eyes either closed or fixed on a spot in front of you. 

2. Direct you attention to the sensation of your feet on the ground (if you are lying down, skip this step and go to step 3). Simply spend 15-20 seconds noticing the sensation of contact with the earth beneath you. If you find yourself distracted by thoughts, feelings or other sensations, just notice the distraction, then bring your attention back to the sensation of the ground under your feet. 

3. Now bring your attention to the sensation of your breathing. When we are anxious/stressed/angry/etc, we tend to breath fast and shallow into the upper chest. So see if you can do the exact opposite: - direct your breath right down deep into your abdomen, and slow down your breathing. Notice the gentle rise and fall of your belly as you breathe. Each time your mind wanders off onto some distraction, just note whatever distracted you and bring your attention back to the breath. 

4. Once your attention has become relatively stable, see if you can make your breathing even deeper … imagine you are breathing so deep down into your belly that it is as though you are sending your breath right down your legs, through your feet, and into the earth beneath you. Obviously you cannot literally do this, but it can be surprisingly calming to imagine this connection between your slow deep breathing and the earth beneath your feet … it tends to generate a sense of being “grounded” , calm and stable. 

5. You can do this exercise for as long or as short as is helpful; always bringing your attention back to the breath each time your mind wanders. Then, when you feel ready, bring the exercise to a close, and redirect your attention to taking mindful action based on the things that are important to you in life. 







Improve the moment:
This skill is all about increasing our tolerance to distress. There will inevitably be times that we feel frustration or anxiety, sometimes there is no immediate solution to change the situation, but we can at least improve what is in our control, our reactions. 

Using the mnemonic IMPROVE:

Imagery:
Close your eyes and imagine relaxing scenery
Imagine hurtful emotions draining out of you like water from a pipe
Remember a happy time and play out this time again in your head
Meaning:
Find purpose or meaning from the difficult situation you find yourself
Focus on whatever positive aspects from the situation that you can find
Repeat these positive aspects in your mind

Prayer:
Prayer can come in any form that works for you and does not have to be religious. The prayer can be to any higher power, including God or the universe. Surrender your problems and ask to tolerate the situation a little longer.

Relaxation:
Massage your neck or scalp
Practice yoga
Breathe deeply
Take a hot bath

One thing in the moment:
Get in the moment by letting go of the future and the past. A singular mind helps emotions to feel less overwhelming, so find one thing to do and focus yourself entirely and completely to that task. 

Vacation:
Give yourself a brief vacation! Get into bed and pull the covers over your head, go to the beach or the woods for the day, read a magazine with a box of chocolates, take a breather from responsibility and stress.

Encouragement:
Encouragement doesn’t need to come from an external source to be effective, voice encouragement to yourself, ‘I can do this!’, ‘This too shall pass’, ‘I am going to get through this moment’


Negative Emotions

Bodily Sensations:

We all know how closely our bodies and minds are connected, emotional distress can be felt as physical pain, metal health can be improved with regular exercise to release endorphins, and with a balanced dietary intake. Anxiety and distress can be felt as physical sensations, which can be unpleasant and increase mental distress, contributing to the anxiety cycle that we are trying to break.  These skills work by changing physical sensations in the body, they are designed to alter your heart rate and body chemistry, so please consider any health conditions you may have before attempting them, if there is conflicting advice, please consult your health professional first.



TIPP skill:

Temperature:
If you put your face into cold water, or hold a Ziplock bag of cold water onto your eyes and upper cheeks whilst holding your breath, it tells your brain you are diving underwater. This causes the natural ‘dive response’ to occur, your body reduces your heart rate, and blood flow is redirected to your heart and brain to provide oxygen, this response can help to regulate your emotions. This works best when you are sitting quietly, activity and distraction will reduce the benefit and the bodies response. 

Intense exercise:
Actively exercising at an intense level can help to change our body chemistry, helping us to better manage our feelings. Endorphins are released by exercise; they interact with receptors in our brains to reduce our perception of pain and increase pleasant feelings in the body. Intense exercise can also be a good way to release energy in a constructive way.


Pace your breathing:
When we feel anxious, our breathing can increase, which can in turn increase anxiety. Slowing down breathing is a very effective way to manage distressing feelings and signals to the brain that we are safe and able to relax. Abdominal breathing is deeper, slower, and happens lower in the body – the belly rather than the chest. Try to breathe in through your nose to the count of 4, pause for one second, then breathe out to the count of 4. Try to ensure your breath is slow, steady, and consistent, pay attention to your out breath, to make sure it is slow and smooth. Pause for one second after your out breath and breath in again through your nose. It may take 5 to 10 minutes for this type of breathing to have an impact, practice the skill a few times a day, try counting to 3 or 5 if things are not working for you counting to 4. 


Progressive muscle scan:
Tension in our bodies increases when we are anxious, when you experience this, scan your body and notice any areas of tension. You may be clenching your fists or your jaw, hunching shoulders, grinding teeth, tensing arms or legs, or other muscles. Gradually and purposefully relax these areas of tension. This skill takes some practice! 
To start, lie down somewhere comfortable with a pillow, or sit in a comfortable armchair.
For each part of your body below, go through three stages in sequence:
First, tense and release – tense your body, hold it for a moment and then release the tension.
Second, lightly tense your body just enough to notice it, then relax.
Third, just pay attention to the group of muscles in that area and release tension from it.

Recommended sequence of muscles:

1.	Right hand and arm (you can clench your fist and tighten muscles in your arm)
2.	Left hand and arm
3.	Right leg (tense your leg, lift your knee slightly)
4.	Left leg
5.	Stomach and chest
6.	Back muscles and shoulders
7.	Neck and throat
8.	Face


Bodily Sensations

Behaviour and avoidance

Although it can be difficult to control our thoughts, we tend to have more control over the actions of our bodies. One of the most effective ways to change the way we feel is to change the way we behave; we can step out of the cycle of anxiety by practicing responding differently. There is a famous quote – If you always do what you’ve always done, you always get what you’ve always got.



STOPP skill – this skill involves improving self-awareness in a situation and controlling our responses. An automatic or default response to a moment of distress can sometimes make a situation worse. 

S - STOP! 
Just pause for a moment. 

T - Take a breath
Notice your breathing as you breathe in and out. In through the nose, out through the mouth. 

O - Observe
• What thoughts are going through your mind right now? 
• Where is your focus of attention? 
• What are you reacting to? 	
• What sensations do you notice in your body? 

P – Pull back and take some Perspective
• DON'T BELIEVE EVERYTHING YOU THINK! 
• What's the bigger picture? 
• Take the helicopter view. 
• What is another way of looking at this situation? 
• What advice would I give a friend? 
• What would a trusted friend say to me right now? 
• Is this thought a fact or opinion? 
• What is a more reasonable explanation? 
• How important is this? How important will it be in 6 months time? 
• It will pass. 

P – Practice what works and Proceed 
• What is the best thing to do right now? 
• What is the most helpful thing for me, for others, for the situation? 
• What can I do that fits with my values? 
• Where can I focus my attention right now?






Pleasant activities. 
Introducing more pleasant daily activities can make our lives more enjoyable, and give us a break from our busy minds and distressing feelings. Unfortunately, many of us are reluctant to engage in pleasant activities because our minds might say that we are undeserving, too tired, too depressed, or too anxious to do them in the first place. However, we often get positively disappointed when we try them out, and the more we engage in these activities the more enjoyable our days tend to become. 

Pleasant Events List 
These are activities that some people find pleasant, but everyone is different. Choose some that you might like to increase your sense of achievement, enjoyment and connectedness with others in your life. Try to schedule some of these activities in your week, or make a list of your own pleasant activities and try to give yourself some time to engage in them.

- Soaking in the bathtub 
- Planning my career 
- Collecting things (coins, shells, etc.) 
- Going on vacation 
- Thinking optimistically about the future 
- Recycling old items 
- Going on a date 
- Relaxing 
- Going to a movie in the middle of the week 
- Jogging, walking 
- Appreciating I have done a full day's work 
- Listening to music 
- Recalling past pleasant social events 
- Playing with household gadgets 
- Lying in the sun 
- Planning a career change 
- Laughing 
- Thinking about my past trips 
- Listening to others 
- Reading magazines or newspapers 
- Hobbies (stamp collecting, model building, etc.) 
- Spending an evening with good friends 
- Planning a day's activities 
- Meeting new people 
- Remembering beautiful scenery 
- Saving money 
- Going home from work 
- Eating 
- Practicing karate, judo, yoga 
- Thinking about retirement 
- Repairing things around the house 
- Working on my car (or bicycle) 
- Remembering the words and deeds of loving people 
- Having quiet evenings 
- Taking care of my plants 
- Going swimming 
- Doodling 
- Exercising 
- Collecting old things 
- Going to a social/cultural event 
- Early morning coffee and newspaper 
- Playing tennis 
- Thinking I have a lot more going for me than most people 
- Playing golf 
- Playing soccer 
- Flying kites 
- Having discussions with friends 
- Having family get-togethers 
- Riding a motorbike 
- Running a track 
- Going camping 
- Singing around the house 
- Arranging flowers 
- Practicing religion (going to church, group praying, etc.) 
- Losing weight 
- Going to the beach 
- Thinking I'm an OK person 
- A day with nothing to do 
- Having class reunions 
- Going skating 
- Going sail boating 
- Traveling abroad or locally 
- Painting 
- Doing something spontaneously 
- Doing needlepoint, crewel, etc. 
- Sleeping 
- Driving 
- Entertaining 
- Going to clubs  
- Singing with groups 
- Playing musical instruments 
- Doing arts and crafts 
- Making a gift for someone 
- Buying records 
- Watching sports 
- Planning social events 
- Cooking 
- Going hiking 
- Writing books or journals (poems, articles) 
- Sewing 
- Buying clothes 
- Going out to dinner 
- Discussing books 
- Sightseeing 
- Gardening 
- Going to the beauty parlour 
- Seeing and/or showing photos or slides 
- Helping others


Anxiety ladder. Avoidance of feared activities can help us feel safe in the short term, but they tend to maintain our distress and restrict our lives in the long-term. Gradually trying out new things and moving out of our comfort zone, whilst making room for any accompanying distress, can make our lives richer and more meaningful. The avoidance hierarchy can help you overcome your anxiety by engaging in things you have been avoiding in a graded manner. An important part of this work involves acknowledging and celebrating your hard work to face the anxiety-provoking activity or situation. So, go easy on yourself, celebrate your achievements, and don’t forget that setbacks are a natural part of the recovery journey. 

Avoidance hierarchy:
Construct a list of places or situations that you avoid, at the top of the list place those which make you most anxious, at the bottom put situations which you avoid, but which don’t bother you too much. In the middle of the list put ones which are in-between. Give each item a rating from 0-100% according to how anxious you would feel doing them. Gradually learn to overcome your anxiety and challenge yourself by starting at the bottom of the list and working your way up. 



In summary, there are many different skills that can help to break the anxiety cycle, those described here are not exhaustive, if you feel awkward engaging with them or that these skills are ‘not for you’, consider browsing the internet for alternatives, or think about how you react and respond at each stage of the cycle, and think about what helps (or makes things worse) at each stage. 

Self-management of anxiety can be a long road, so celebrate the small wins, recognise when something you have managed has made a difference to your mental state, it is a sign of improvement and that you are coping better. Don’t be too hard on yourself, every human in the world experiences anxiety and we have all experienced days when anxiety has got the best of us. Don’t give up, and don’t be afraid to talk to your family, friends, or health professionals about your anxiety if you need more help. 


Lesson 1

Behavioural Adjustments

Anxiety is a natural response that we all experience, although cycles of anxiety can be difficult to break and can reinforce or exacerbate anxiety. This course explores skills and techniques to help manage, reduce and control. anxiety.

Guidance and skills to break to break the cycle of anxiety

Breaking the cycle of Anxiety

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