Anxiety & Depression Student Workbook · 2020-04-21 · Page 3 CAPS Getting Unstuck Workbook (479) 575-5276 (24/7) Health.uark.edu Welcome! Welcome to Anxiety and Depression Reduction

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GettingUnstuckWorkbook(479)575-5276(24/7) Health.uark.edu

Anxiety&Depression

ReductionWorkbook

StudentWorkbook

CounselingandPsychologicalServices

UniversityofArkansas(479)575-5276health.uark.edu

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TableofContents

Welcome&FrequentlyAskedQuestionsConfidentialityInSessionWorksheetsSession1:UnderstandingAnxiety&DepressionSession1:SquareBreathingSession1:ShortRelaxationTechniquesSession1:UnderstandingDepressiveDisordersSession1:StressVersusAnxietySession1:UnderstandingAnxietyDisordersSession1:StressCurve&AvoidanceRollerCoasterSession1:ThreatSystemSymptomsSession2:SelfCareSession2:Breath-CountingExerciseSession2:SleepHygiene&ExerciseTipsSession2:CoreValuesAssessmentSession2:Self-CareWorksheetSession2:PleasantActivitiesListSession3:TheCognitiveBehavioralModelSession3:ProgressiveMuscleRelaxationScriptSession3:CommonAnxietySymptomsSession3:CommonDepressiveSymptomsSession3:Example:CrossSectionalFormulation(Anxiety)Session3:Example:CrossSectionalFormulation(Depression)Session3:CrossSectionalFormulation(Blank)Session3:FeelingsWheelSession3:CrossSectionalFormulation(Blank)Session4:AutomaticThoughtsandUnhelpfulCognitionsSession4:“54321”GroundingExerciseSession4:UnhelpfulThinkingStylesSession4:UnhelpfulBehaviorsSession4:CrossSectionalFormulation(Blank)Session4:MaintainingDepressedMoodWorksheetSession4:MaintaininganAnxiousStateWorksheetSession5:AlternativeResponsesSession5:GuidedImagerySession5:IdentifyingTriggersWorksheetSession5:Self-AffirmationsWorksheetSession5:Example:AlternativeResponseWorksheet(Anxiety)Session5:Example:AlternativeResponseWorksheet(Depression)Session5:AlternativeResponseWorksheet(Blank)Session5:Ifyou’rehavingtrouble…AlternativeThoughtQuestionsSession5:Ifyou’rehavingtrouble…Behavior&FeelingsQuestionsSession5:OtherHelpfulThoughtTipsSession5:MyPlanforManagingAnxiety/DepressionAppendixOnlineResourcesApps&booksHelpfulBehavioralTipsBehavioralTipsforManagingDepressionGroundingExercisesCrossSectionalFormulation(Blank)AlternativeResponseWorksheet(Blank)

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Welcome!

WelcometoAnxietyandDepressionReductionWorkshop,aworkshopintendedtohelpincreaseyourunderstandingandknowledgeaboutanxietyanddepression.Thegoalofthisseminaristoprovideyouwithlife-longtoolsyoucanusewhilefacinganxietyordepressiontriggeringsituations.Thegoalistoprovideyouwithsomeskillstorecognizeandmanagesymptomsyoumaybeexperiencing.Remember,thisinterventionisnotintendedto“getridof”youranxiety/depression.Ourhopeisthatthesefivesessionsprovideyouwithajumpingboardfromwhichtointegrateskillsintoyourdailylifeintheserviceofreducinganxiety.Bytheendofthiscourse,youwillhavereceivedalotofinformationandattimesitmayfeeloverwhelming.Rememberthatlikeanyskill(e.g.,learningtorideabike),theskillsyouwilllearninAnxietyanddepressionReductionWorkshoptaketimeandpracticetomaster.Attimes,youmayencounterobstaclesand/orfinditdifficulttointegratetheseskillsintoyourdailylife.That’sokay,it’showchangeworks,andaswithallchange,it’simportanttopracticeasmuchasyoucan,evenafterencounteringsetbacks.Thinkofyourpracticeoftheseskillsasaformof“mentalhealthhygiene.”Attheoutset,itmayseemtediousandyoumayquestionwhyyouneedtopracticetheseskillssooften.Thinkofitlikedentalhygiene—youbrushyourteethmultipletimesadaytopreventthebuildupofplaqueandultimatelytopreventcavities.Similartobrushingyourteeth,dailypracticepreventsabuildupofsadnessandanxietyovertimeandcanminimizeandpreventlong-termsymptoms.Themoreyoupracticeandusetheseskillsaspartofyourdailyroutine,thelesstedioustheymayseembecausetheysimplybecomearegularpartofdailylife.Shouldyouwishtofocusmoreindepthonanyofyourdepression-relatedoranxiety-relatedconcerns,youmaydebriefwithatherapistfollowingcompletionofworkshoptodiscussoptions.Ifatanytimeyoufeelthatyouneedadditionalsupport,pleaseletyourleaderknoworcontactCounselingServicesat(479)575-5276.Youmayalsofindadditionalresourcesonlineathealth.uark.edu/mental-health/.

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FrequentlyAskedQuestions(FAQ)WhatifIhaveanurgentneedtoseeacounselorduringtheworkshop?SimplyletthefacilitatororCounselingServices’frontdeskstaffknowandtheywillfacilitateyougettingthehelpyouneed.WhatifIneedmorethan5weekstolearnthemodel?Youarenotalone.Theskillsaredifficultandtaketimetobuild.Ifyouneedmoreresources,weencourageyoutofollow-upwiththegroupfacilitator.WhatifIdon’tfeelcomfortableingroups?Manypeoplefeelalittleanxiousaboutparticipatinginagroup.Thisworkshopisstructuredandcurriculum-driven,likeaclass.Youarenotrequiredtospeakifyoudonotfeelcomfortabledoingso.Thefacilitatorsrespecteachparticipant’srighttoshareonlywhattheyarecomfortablesharingandneverrequireyoutosharesensitiveorpotentiallyembarrassinginformation.WhydoIhavetodohomework?Thefocusofthisworkshopisonbuildingskillstocopewithanxiety/depression;inordertoachievethatgoal,regularpracticeisessential.Themoreyoupractice,themoreyoumayfindyougetoutofthisworkshop.Theassignmentsareforyouandonlyyou,intheserviceofyourownpersonalgrowth.Youwillnotberequiredtoprovideyourresponsesatanytimeduringthisworkshop;however,it’simportanttobringyourresponsesasyoumaybeaskedtolookbackonorelaborateonapriorassignmentduringtheworkshop.WhatifIdidn’tdomyhomework?Weencourageyoutocometogroupregardlessofwhetherornotyouwereabletocompletethehomeworkassignment.Ifyouforgetyourworkbook,wecanprovideyouanewone.Wecanalsoassistyouinworkingonexampleswhenthehomeworkisreviewed.

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Confidentiality Contract for Workshop/Group

1. ThisinstrumentisacontractforconfidentialityamongthemembersofthisgroupandfortheareaofCAPS.

2. Eachmemberoftheworkshop/groupacknowledgestheneedtokeeppersonal

informationsharedintheworkshop/groupprivate.

3. Forthepurposeofthisworkshop/group,anyinformationsharedbyaworkshop/groupmembershouldbeconsideredpersonalandprivateinformation.

4. Inordertobecomeaworkshop/groupmemberandmaintainmembership,each

personmustagreetoprotectthisprivateinformation.Informationgatheredaboutothermembersoftheworkshop/groupcannotbesharedwithanyoneelse.Thatinformationshallremainwiththeworkshop/groupmembersandnotbetransmittedorcommunicatedtootherpeople.

5. Eachmemberagreestosilencephonesandnottakeanyphotographsorpostinsocialmediaaboutmembersoftheworkshop/group.

6. Eachmemberoftheworkshop/groupagreestokeepconfidentialtheidentityofanyothersseenatCAPSinordertoprotecttheirconfidentiality.

7. Ifyouagreetoabidebytheserestrictions,pleaseacknowledgeyouragreementby

signinginthespacebelow.________________________________ ________________________NameofWorkshop/Group StudentIDNumber ___________________________________________ ________________________Signatureofgroupmember Date___________________________________________ ________________________PrintedNameEmail _________________________________________________ ________________________Address:City,State,ZipCellphone#___________________________________________ ________________________Signatureofworkshop/groupfacilitator Date

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INSESSIONWORKSHEETS

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SESSION1:Understanding

Anxiety/Depression

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SquareBreathing

1. Placeonehandonourstomachandoneonourchest.Youwanttofeelthehandonourstomachmoveinandoutmorethanthehandonourchest.

2. Takeadeepbreathinthroughyournose.Asyouinhaleyoucountinyourmind1…2…3…4andyouimagineusingtheairyoubreatheintopushagainstyourhandonyourstomach.

3. Holdforacountof4.Thenyouexhalethroughyourmouthlikeyouareblowingoutacandle.

4. Exhaleforacountof1…2…3…45. Pauseforacountof4beforestartingagain.

HelpfulPracticeTips:

• Practicethesetechniquesdaily.• Chooseaconsistenttimeeachdaythatisfreefromdistractionsandcalm.(Beforebedisagreattimebecauseitcanalsohelpwithdifficultiesfallingasleep)

• Practicethesestrategiesinacalmenvironmentandconsistentlyinordertoincreaseyourabilitytoaccessthemwhenyouarestressed/anxious.

• Themoreyoupracticethesestrategiestheeasiertheywillbetoaccesswhenyouareanxious.

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ShortRelaxationTechniques:Whenyouonlyhaveafewminutes

CorrectBreathing Learntoalwaysbreatheusingthediaphragm.Letthebreathreachthebottomofthelungs,andletthechestandshouldersrelax.High,shallowchestbreathingisstressfulandgivesmessagesofstresstothebrain.

Three-PartBreathing

Takeadeepbreathandimaginethelungsdividedintothreeparts.Visualizethelowestpartofthelungsfillingwithair;thechestshouldremainrelativelystill.Imaginethemiddlepartofthelungsfilling;visualizetheribcageexpanding.Visualizetheupperpartfillingwithairasyourshouldersriseslightandoverbackward.Exhalefullyandcompletely;dropyourshoulders,feelyourribcagecontract,andforceeverybitofairfromthebottomofthelungs.Repeat.

Stretching Gentlyrollyourheadandshouldersmanytimesaday.Also,gentlystretchotherareasofthebodythatmayneedit.

Tense-RelaxMuscles Tightenthemusclesyouwanttorelaxandfeelthetension.Letthemusclesbecomelooseandlimpandfeeltherelaxation.

BodyScan Withyourmind,brieflyscaneverymuscleinyourbodyfromyourtoestoyourhead.Releaseanytensionwitharelaxingbreath.Correctyourpostureandrelaxallthemusclesyouarenotusing.

JawDrop Beawareofanytightnessinyourjaw.Allowyourjawtoloosenbyseparatingyourteeth.

HeavinessandWarmthinHands&Arms

Relaxyourbodyandfeelheavinessinyourarmsandhands.Imagineawarmthflowingthroughthem.Imagineandexperiencesyourshoulders,arms,andhandsbecomingheavy,relaxed,andwarm.

Mind-QuietingMeditation

Beginbyfocusingonyourbreathing.Useaspecialphrasethathelpsyoufocusonrelaxation,andquietyourmind.

Attitudes&Perceptions

Payattentiontoyourperceptionsandattitudes.Allowyourselftoputastress-reducing“frame”aroundthestressor.Remember,stressaffectsthebodybasedonyourperceptionsoftheoutsideworld.

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UnderstandingDepressiveandotherRelatedDisorders

Whilesomedepressivesymptoms(i.e.,sadness)areanormalexperienceforeveryone,depressiveandotherrelateddisordersarecharacterizedbysignificantdistressorimpairmentinsocial,academic/occupational,orotherimportantareasoffunctioning(e.g.,yourgeneralabilitytofunctioninlife).

Someofthemostcommondisordersinclude:

MajorDepressiveDisorder:

Involvesexperiencingdepressiveepisodes,whichmustlastfortwoweeks,andincludeaminimumof5symptoms.

PersistentDepressiveDisorder:

Alessextremedepressivepresentationthatincludesadepressedmoodandatleast2othersymptomsthatlastforatleasttwoyears.Mayhaveepisodesofmajordepressionalongwithperiodsoflessseveresymptoms,butsymptomsmustlastfortwoyears.

PremenstrualDysphoricDisorder:

Severaldepressivesymptomspresentconsistentlyduringtheweekpriortomenses.

BipolarIIDisorder: Includesexperiencesofbothdepressiveepisodesaswellas"mixed"orhypomanicepisodes(i.e.,elevatedmoodwithotherexpansivesymptoms).

CyclothymicDisorder:

Persistentperiodsofalternatingbetween"highs"and"lows"thataresubthresholdforhypomanicanddepressiveepisodes.

DisruptiveMoodDysregulationDisorder:

Recurrenttemperoutburstsandpersistentlyirritableorangrymoodforatleastoneyear(presentbetweenages6-18).

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StressversusAnxiety

EverydayAnxiety(Stress) AnxietyDisorder

Inresponsetoaknownenvironmentalfactor

Inresponsetoanunknownsourceorinresponsetotheexperienceofstress

Symptomsgoawaywhenthestressorgoesaway

Symptomsremaindespitenoidentifiablestressor

Worryaboutlivingawayfromhomeforthefirsttime,passingaclass,aromanticbreakup,orotherimportantlifeevents

Constantandunsubstantiatedworrythatcausessignificantdistressandinterfereswithyourdailylife

Embarrassmentorself-consciousnessinanuncomfortableorawkwardsocialsituation;feelingnervousaboutmeetingnewpeople

Avoidanceofsocialsituationsduetofearofbeingjudged,embarrassed,orhumiliated

Feelingnervousorsweatingbeforeabigtest,classpresentation,stageperformance,orothersignificantevent

Panicattacksthatseemoutoftheblueandpreoccupationwiththefearofhavinganotherone

Realisticfearofadangerousobject,place,orsituation(e.g.fearofpoisonoussnakes)

Irrationalfearoravoidanceofanobject,place,orsituationthatposeslittleornothreatofdanger(e.g.fearofelevators)

Makingsurethatyouarehealthyandlivinginasafeenvironment

Performinguncontrollablerepetitiveactions,suchasexcessivecleaning,checking,touchingorarranging

Adaptedfrom:http://www.adaa.org/understanding-anxiety

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UnderstandingAnxietyDisordersWhileanxietyisanormalandadaptiveexperienceforeveryone,anxietydisordersarecharacterizedbysignificantdistressorimpairmentinsocial,academic/occupational,orotherimportantareasoffunctioning(e.g.,yourgeneralabilitytofunctioninlife).Someofthemostcommonanxietydisordersinclude:GeneralizedAnxietyDisorder: Chronicandunrealisticworrythatfeels

difficulttocontrolabouteverydaythings(i.e.,thingsthatdonotworrymostpeople)

SocialAnxietyDisorder: Chronicworrysolelyrelatedtosocial

situationsPanicDisorder: Characterizedbyepisodesof“panic”that

includethingslike:adrenalinesurge,fearoflosingcontrol,chestpain,racingheart,shortnessofbreath,dizziness

Phobias: Specificfearsthatareexcessiveinnature

andoftenleadtoavoidingthatwhichisfeared(e.g.,publicspeaking,heights,tunnels,etc.)

Obsessive-CompulsiveDisorder: Excessiverumination(thinking)with

repetitivebehaviorstoreduceanxiety

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Anxiety-AvoidanceRollerCoaster

Adaptedfrom-http://www.therapistaid.com/therapy-guide/cbt-for-anxiety

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Threat System (Fight or Flight)

Thoughts racing

Breathing becomesquicker and

shallower

Heart beats faster

Adrenal glandsrelease adrenaline

Bladder urgency

Palms becomesweaty

Muscles tense

Dizzy or lightheaded

The ‘fight or flight’ response gets the body ready to fight or run away. Once a threatis detected your body responds automatically. All of the changes happen for goodreasons, but may be experienced as uncomfortable when they happen in ‘safe’ situations.

helps us to evaluatethreat quickly and makerapid decisions, can be hardto focus on anything butthe feeling of danger

to take in more oxygenand make our body moreable to fight or run away

adrenaline signals otherorgans to get ready

feeds more blood tothe muscles and enhances ability tofight or run away

the body sweats to keep cool, thismakes it a more efficient machine

Changes to visiontunnel vision, or visionbecoming ‘sharper’

Dry mouth

muscles in the bladder relaxin response to stress

ready to fight or run awaythey may also shake ortremble

Hands get coldblood vessels in the skincontract to force bloodtowards major musclegroups

PSYCHOLOGYT LS http://psychology.tools

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SESSION2:Self-Care

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Breath-CountingExercise

Thisexercisefocusesontheuseofcountingwiththerhythmofthebreath.Startwithashortperiodoftimeandgraduallyincreasethetime.Setatimersothatyoudonothavetoworryaboutwhentostop.1. Findacomfortableposition.Takeseveraldeepbreathsandsettleintoyourself.Youmayeithercloseyoureyesorkeepthemopen,dependingonyourowncomfort.Ifyoukeepthemopen,fixthemonanobjectoraspotontheflooraboutfourfeetinfrontofyou.Youreyesmaybeeitherfocusedorunfocused.

2. Takedeep,comfortablebreaths.Noticeyourinhalation.Thepausebetweeninhalingandexhaling,yourexhalation,andthepausebeforestartingagain.

3. Asyouinhale,count,“one...”Asyouexhale,count,“two...”Inhale,“three...”Exhale,“four...”Continueuntilyoureach10thenstartover.

4. Ifyoulosecount,simplybeginwith“one”onyournextinhalation.5. Ifyounoticeyourmindhaswandered,gentlynoticethis,andreturnyourfocusbacktocountingyourbreath

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SleepHygiene

1. Getregular.Gotobedandgetupatmoreorlessthesametimeeveryday,evenonweekendsanddaysoff!

2. Getupandtryagain.Trytogotosleeponlywhentired.Ifyouhaven’tbeenabletogettosleepafterabout30minutes,getupanddosomethingcalming(notstimulating)untilyoufeelsleepy,thenreturntobedandtryagain.

3. Avoidcaffeineandnicotine.Avoidconsuminganycaffeine(coffee,tea,soda,chocolate)ornicotine(cigarettes)foratleast4-6hoursbeforegoingtobed.Theseactasstimulantsandinterferewithfallingasleep.

4. Avoidalcohol.Avoidalcoholforatleast4-6hoursbeforebedbecauseitinterruptsthequalityofsleep.

5. Bedisforsleeping.Trynottouseyourbedforanythingotherthansleepingandsex,sothatyourbodycomestoassociatebedwithsleep.

6. Electronicscurfew.Don’tuseback-litelectronics60minutespriortobed,astheartificiallightinhibitshormonesandneuronsthatpromotesleep.

7. Nonaps.Avoidtakingnapsduringtheday.Ifyoucan’tmakeitthroughthedaywithoutanap,makesureitisforlessthananhourandbefore3pm.

8. Sleeprituals.Developritualstoremindyourbodythatitistimetosleep,likerelaxingstretchesorbreathingexercisesfor15minutesbeforebed.

9. Noclock-watching.Checkingtheclockduringthenightcanwakeyouupandreinforcesnegativethoughtssuchas,“Ohno,lookhowlateitis,I’llnevergettosleep.”

10. Therightspace.Makeyourbedandbedroomquietandcomfortableforsleeping.Aneyemaskandearplugsmayhelpblockoutlightandnoise.

11. Keepdaytimeroutinethesame.Evenifyouhaveabadnight’ssleep,itisimportantthatyoutrytokeepyourdaytimeactivitiesthesameasyouhadplanned.Thatis,don’tavoidactivitiesbecauseyoufeeltired.Thiscanreinforcetheinsomnia.

ExerciseTips

1. Findanenjoyableactivity.Exercisedoesn’thavetobeboring.Chooseapleasurableactivity,likeplayingbadmintonordoingyoga.Aimforfun,notmorework.

2. Startsmall.Committo10minutesofexerciseadayoraddexercisetoyourdailyroutine(likewalkingtoschoolordoingpush-upsinyourroom).

3. Getoutside.Thesunprovidesamood“pickmeup”ofitsown,producingserotonininthebrain.Takeawalkoutsideorgoswimming.

4. Scheduleitin.It’seasytoskipexercisewhenwedon’tplan.Putitinyourphoneaspartofyourdailyto-do’sandcelebratewhenyoucheckitoff.

5. Mixitup.Toavoidfeelingboredwithexercise,tryanumberofdifferentactivities.

6. Teamup.Depressioncanbeisolating.Askotherstodoteamactivitiesorfindanexercisebuddyforaccountabilityandtoincreasesocialinteraction.

7. Minimizeequipment.Equipmentcanbeexpensive.Identifyactivitiesthatdon’trequireyoutohaveequipmentorfacilities,likewalking,running,ordancing.

8. Followyourenergy.Ifyourenergyfluctuatesthroughouttheday,trytoplantoexercisewhenyourenergyisatitspeak.Alternatively,exercisewhenfeelingsluggishforanenergyboost.

9. Setgoals.Achievinggoalsimprovesmoodandself-esteem.Setspecificachievableexercisegoalsandrewardyourselfwhenyouaccomplishthem.

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AnxietyToolboxWorkbook(479)575-5276(24/7) Health.uark.edu

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SELF-CARE WORKSHEETRatecurrentuseofwellnesspracticesinyoureverydaylife0(non-existent)to5(useeveryday).Wellnesspracticescaninclude,pleasantactivities,yoga,meditation,journaling,etc.)Whatareyourcurrentroadblockstoeffectiveself-care?

Whatself-care/wellnesspracticewouldyouliketoimplement?Whatvaluesunderlinethis

goal?(seelist)

TIPSTOIMPLEMENTINGEFFECTIVESELF-CARE:

• Choosewhatwellnesspracticeyouaregoingtoimplement(seethelistbelowifyoudonothaveactivityyouwouldliketoimplement)

• Createaschedulewhenyouaregoingtoimplementtheactivity• Sticktothesamescheduleeveryday• Identifyhowyouwillovercomearoadblockifitpresentsitself

Whatisyourplantoimplementeffectiveself-care?

Thesmallest,easieststepIcanbeginwithis:

Thetime,day,anddatethatIwilltakethefirststepis:

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PleasantActivities

Acting Amusingpeople

Attendingaconcert

Beachcombing Beingalone Beingwithanimals

Beingatthebeach

Beingcomplimented Beingcoached Beingcounseled

Beinginthecountry

Beingatafamilyget-together

Beingatafraternity/sorority

Beingwithfriends

Beingwithhappypeople

Beinginthemountains

Beingwithmyroommate

BeingwithsomeoneIlove

BeingtoldIamloved

Beingwithmyparents

Bird-watching

Boating/canoeing Budgetingmytime

Buyingthingsformyself

BuyingsomethingforsomeoneIcare

about

Camping Caringforplants

Canning/Makingpreserves

Cheeringforsomething

Collectingthings

Combing/brushingmy

hair

Completingadifficulttask

Complimentingorpraisingsomeone

Cooking Counselingsomeone

Dancing DatingsomeoneIlike

Designing/Drafting

Discussingmyfavoritehobby

Doingartwork Doingexperiments

DoingfavorsforpeopleIlike

Doinghousework Dreamingatnight

Drivinglongdistances

Eatinggoodmeals

Exploring/Hiking

Expressinglovetosomeone

FeelingthepresenceofaHigherPower

Fishing Fixingmachines

Gardening/Doing

yardwork

Gatheringnaturalobjects

Givinggifts Givingapartyforsomeone

Gettingupearly

Gettingmassages Givingmassages

Goingtoanamusementpark/zoo

Goingtoabarber/beautician

Goingtoaconcert

Goingtolectures

Goingtoaluncheon/potluck

Goingtoahealthclub/sauna/spa

Goingtothemovies

Goingtoamuseum

Goingonnaturewalks/field

trips

Goingtoaplay Goingtoarestaurant

Goingtoareunion

Goingtoaspiritual/peacefulplace

Goingtoasportsevent

Havingcoffee/teawith

friends

Havingdaydreams

Havingfriendsovertovisit

Havingalivelytalk

Havinglunchwithfriends

Kickingsand/pebbles/leaves

Kissing Knitting/crocheting

Laughing Learningsomethingnew

Listeningtotheratio

Listeningtomusic

Lookingatthestars/moon

Makingcharitabledonations

Makingfoodtogiveaway

Makinganewfriend

Meditating/Doingyoga

Planningororganizingsomething

Playingsports

Playingcards Playingmusic Playingwithapet

Playinginnature

Playingaboardgame/chess

Photography Repairingthings

Reading Reminiscing Ridinginanairplane

Running/jogging

Sayingprayers Seeingbeautifulscenery

Seeingoldfriends

Sewing Shaving Singing Sleepinglate Smellingaflowerorplant

Seeinggoodthingshappentopeople

Solvingapuzzle/crossword

Speakingaforeignlanguage

Stayinguplate Smilingatpeople

Takingabath Usingmystrengths

WatchingTV Writinginajournal

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SESSION3:TheCognitiveBehavioralModel

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ProgressiveMuscleRelaxationScript

• Sitbackor,whenyouareathome,liedowninacomfortableposition.Shutyoureyesifyou’recomfortabledoingso;ifnot,softenyourgazeonafixedpoint.

• Startbytakingadeepbreathandnoticingthefeelingofairfillingyourlungs.Holdyourbreathforafewseconds.One…..two….three...Releasethebreathslowlyandletthetensionleaveyourbody.

• Now,takeanotherdeepbreathandholdit.One…..two….three….Slowlyreleasetheair.• Evenslowernow,takeanotherbreathin.Fillyourlungsandholdthebreath.One…..two….three.Slowlyrelease

thebreathandimaginethefeelingoftensionleavingyourbodywitheachbreathout.• Wearegoingtobeginprogressivelytensingandreleasingourmuscles.Let’sstartbyclenchingourfists,tighter

andtighter.Hold.Studythetensioninyourfists,wristsandforearmsasyouholdtheclenchedfist.(5secondpause).Nowletgoandrelaxyourhands.Feeltheloosenessinyourhandsandnoticethecontrastbetweenthetensionandthefeelingofrelaxation.(5secondpause)

• Nowbendyourelbowsandtenseyourbiceps.Tensethemashardasyoucanandobservethefeelingoftautness.Hold.(5secondpause).Okay,relax.Straightenoutyourarms.Noticethefeelingofrelaxationinyourhands,arms,andshoulders.Noticehowyourarmsfeellimpandatease.(5secondpause)

• Okay,let’sturnourattentiontoourhead.Wrinkleyourforeheadastightasyoucan.Hold.(5secondpause)Nowrelaxandsmoothitout.(5secondpause)

• Nowcloseyoureyes,squintthemtighter.Feelthetension.(5secondpause).Now,relaxyoureyes.Letthemremainclosedgentlyandcomfortably.(5secondpause)

• Okay,stillfocusingonourheads,rollyourheadtotherightandfeelthechanginglocusofstress,rollittotheleft.(5secondpause)

• Straightenyourheadandbringitforward.Pressyourchinagainstyourchest.Feelthetensioninyourthroat,thebackofyourneck.Hold.(5secondpause)Relax,allowingyourheadtoreturntotacomfortableposition.Lettherelaxationdeepen.(5secondpause)

• Next,tensethemusclesinyourbackbybringingyourshoulderstogetherbehindyou.Holdthemtightly.Tensethemashardasyoucanwithoutstrainingandkeepholding(5secondpause).Nowletgo.Releasethetensionfromyourback.Feelthetensionslowlyleavingyourbody,andthenewfeelingofrelaxation.Noticehowdifferentyourbodyfeelswhenyouallowittorelax.(5secondpause)

• Nowshrugyourshouldersuptoyourearsandhold.(5secondpause)Relaxyourshoulders.Dropthembackandfeeltherelaxationspreadingthroughyourneck,throatandshoulders.Giveyourbodyachancetorelax.Feelthecomfortandtheheaviness.(5secondpause)

• Next,breatheinandfillyourlungscompletely.Holdyourbreath.Noticethetension.(5secondpause)Nowexhale.Lettheairhissoutandletyourchestbecomeloose.Continuerelaxing,lettingyourbreathcomefreelyandgently.(5secondpause)

• Nowtightenyourbuttocksandthighs.Squeezeyourthighsashardasyoucanandhold.(5secondpause).Release.Feelthedifferenceasyouletgo.(5secondpause)

• Nowlet’smoveourattentiontothecalvesandfeet.Pressyourtoesdownward,makingyourcalvestense.Studythetension.(5secondpause).Relax.(5secondpause).

• Nowbendyourtoestowardsyourface,creatingtensioninyourshins.(5secondpause).Relaxagain.(5secondpause).

• Okay.Finally,tenseyourentirebody.Tenseyourfeet,legs,stomach,chest,arms,head,andneck.Tensehard,withoutstraining.Holdthetension.(5secondpause).Relax.Feeltheloosenessandheavinessthroughoutyourbodyastherelaxationdeepens.Letgomoreandmore.Experiencetherelaxationdeepening.Payattentiontothefeelingofrelaxation,andhowdifferentitisfromthefeelingoftension(Wait10seconds).

• Begintowakeyourbodyupbyslowlymovingyourmuscles.Adjustyourarmsandlegs.Stretchyourmusclesandopenyoureyeswhenyou’reready.

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CommonAnxietySymptomsPhysicalSymptoms

o Increasedheartrateo Shortnessofbreatho Chestpainorpressureo Chokingsensationo Dizziness,lightheadednesso Sweating,hotflashes,chillso Nausea,upsetstomach,diarrhea

o Trembling,shakingo Weakness,unsteadiness,faintness

o Tensemuscles,rigidityo Drymoutho Other:________________________

BehavioralSymptoms

o Avoidanceofthreatcuesorsituations

o Escape,flighto Pursuitofsafety,reassuranceo Restlessness,agitation,pacing

o Hyperventilationo Freezing,motionlessnesso Difficultyspeakingo Other:___________________________

CognitiveSymptomso Fearoflosingcontrol,beingunabletocope

o Fearofphysicalinjuryordeath

o Fearof“goingcrazy”o Fearofnegativeevaluationsbyothers

o Frighteningthoughts,images,ormemories

o Perceptionsofunrealityordetachment

o Poorconcentration,confusion,distractibility

o Narrowingofattention,hypervigilanceforthreat

o Poormemoryo Difficultyinreasoning,lossofobjectivity

o Other:___________________________

EmotionalSymptomso Feelingnervous,tense,woundup

o Feelingfrightened,fearful,terrified

o Beingedgy,jumpy,jitteryo Beingimpatient,frustratedo Other:________________________

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CommonDepressiveSymptomsBehaviors Thoughts Emotions Physical

SensationsIncreasedorreducedsleep

Reducedfocus/concentration

LowMoodorpersistentsadness

Fatigueorlowenergy

Withdrawingfromfriends,family,pets

Suicidalthoughtsorpreoccupationwithdeath

LossofPleasureforthingsyouusedtoenjoy

Unexplainedachesandpains

"self-medicating"withalcoholorotherdrugs

Self-criticism

Angerorirritability

"heaviness"inthebody

Changestoeatingorweight

Worryaboutsomethingawfulhappening

Guilt Appetitedisruption

Suicideattempts Fearofrejection Numbnessorfeelingsofemptiness

Gastrointestinalproblems

Physicalrestlessnessorslowing

Inabilitytomakedecisions

Hopelessness Changestosexdrive

Poorhygiene

CryingSpells

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AnxietyCrossSectionalFormulation

Situation(When?Where?What?Withwhom?Whatdidyoufeelanxiousabout?) Astudentinvitedmetoapartyinmyresidencehall,butIdidn’tknowherverywellandfeltanxiousaboutgoing.

Physical(Whenanxious,whatphysicalsensationsdidyouexperience?Whatdidyounoticeinyourbody?) Heartracing,tightchest,shallowbreathing,hot

Cognitive(Whatwentthroughyourmindwhenyoufeltanxious?Whatdidthatsayormeanaboutyouorthesituation?) Iwon’tknowanyoneatthepartyandwillfeelawkward.NoonewilllikemebecauseI’msosociallyawkward.Iwon’thavefun.ButifIsayno,thispersonwon’tlikemeandIwouldn’tmakefriends.

Behavioral(Whatwasyourfirstinstinctand/orautomaticresponse?Whatdidyoudoand/oravoiddoingatthetime?)Myfirstinstinctwastosayno.IavoidedsayingnobuttellingherthatIwouldthinkaboutit.Inevergotbacktoher.Ididn’tgototheparty.

Emotional(Whatemotionscameupforyouwhenyoufeltanxious?) Scared,ashamed,Lonely,agitated,nervous

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DepressionCrossSectionalFormulation

Situation(When?Where?What?Withwhom?)Ihaveagroupassignmentdueformyclass.Iaskedafellowclassmatetobemypartner,butshedeclined.

Physical(Whendepressed,whatphysicalsensationsdidyouexperience?Whatdidyounoticeinyourbody?)Upsetstomach,tired,lostmyappetite,gotreallyhot

Emotional(Whatemotionscameupforyouwhenyoufeltdepressed?)Sad,ashamed,embarrassed,rejected,lonely,irritable

Cognitive(Whatwentthroughyourmindwhenyoufeltdepressed?Whatdidthatsayormeanaboutyouorthesituation?)IknewIshouldn’thaveaskedher;she’swaysmarterthanmeandsheknowsit.Ifwehadworkedtogether,Ionlywouldhavebroughtdownthegrade.I’msostupid.Shemusthateme.

Behavioral(Whatwasyourfirstinstinctand/orresponse?Whatdidyoudoand/oravoiddoing?)Iwanttoavoidaskinganyoneelseincasetheysayno.Ileftclassearlyandhaven’tfoundapartnertoworkwith.I’llavoidtalkingtoherinthefuture.

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Physical(Whenanxious/depressed,whatphysicalsensationsdidyouexperience?Whatdidyounoticeinyourbody?)

Cognitive(Whatwentthroughyourmindwhenyoufeltanxious/depressed?Whatdidthatsayormeanaboutyouorthesituation?)

Behavioral(Whatwasyourfirstinstinctand/orautomaticresponse?Whatdidyoudoand/oravoiddoingatthetime?)

CrossSectionalFormulation

Situation(When?Where?What?Withwhom?Whatdidyoufeelanxious/depressedabout?)

Emotional(Whatemotionscameupforyouwhenyoufeltanxious/depressed?)

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FeelingsWheel

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SESSION4:AUTOMATICTHOUGHTS

ANDUNHELPFULCOGNITIONS

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“54321”GroundingExercise

o Name5thingsyoucanseeintheroomwithyou.

o Name4thingsyoucanfeel(tactile;e.g.“chaironmyback”or“feetonfloor”)

o Name3thingsyoucanhearrightnow

o Name2thingsyoucansmellrightnow

o Name1youcantasteor1goodthingaboutyourself

***Additionalgroundingtechniquescanbefoundintheappendixonpages57&58***

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UnhelpfulBehaviors

Getupatdifferenttimeseverymorning

Gotobedatdifferenttimeseverynight

Missclass Don’tdoahomeworkassignment

Waituntilthelastminutetogetsomethingdone

Stopwashingyourhair

Stopbrushingyourteeth

Skipatest Stopgoingtoteamorclubmeeting

Ignoreordeclineinvitestohangout

Skipameal Overeat

Eatlotsofjunkfood

Bingedrink Smokecigarettes

Stoptalkingto/activelyavoidyourfriends

Stoptalkingto/activelyavoidyourfamily

Don’tseekhelpwhenyouarestruggling

Stayinsideallthetime

Playvideogamesforhours

Constantlymonitorsocialmedia

Stayinyourbed

Stayinyourroom;don’tleave

Stoptalkingtoyourroommate

Stopcompletingtasks

Stopgoingtowork

Stopexercising

WatchalotofTV

Onlyeatonemealaday

Arguewithotherpeople

Stopdoingyourhobbies

Onlyfocusonthenegative

Complainalot

Userecreationaldrugs

Sleepallday Don’tmove

Onlylistentomusicthatmakesyousad,angryorupset

Stopsmilingandlaughing

Stopgoingtochurch,meditatingorpraying

Letyourroomgetreallydisorganized

Self-harm Smokemarijuana

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MaintainingDepressedMood

Yourtaskistobeacuriousinvestigatororscientistinthestudyofyouforatleasttwodaysthisweek.Whatareyourthoughtandbehaviorpatternsthatperpetuatefeelingdepressed?Whatperpetuatesfeelingokayorgood?Whatisnotworkingandwhatisworking?ThingsIthinkanddothatmaintainmydepressedmood:Examplesofthoughts:Magnification,disqualifyingthepositive,emotionalreasoningExamplesofbehaviors:Skipmeals,stopexercising,stayuplate,stopshowering,missclass,avoidfriends

Day Thoughts Behaviors1

2(SatorSun)

ThingsIthinkanddothathelpmefeelokay,good,and/oraccomplished:Examplesofthoughts:Complimentyourself,giveyourselfcreditfordoingsomething,talkbacktoyournegativethoughts,remindyourselftobegentletoyourself,thinkaboutagoodmemoryExamplesofbehaviors:Readabookforfun,gotoaclubmeeting,brushmyteethatnight,gotothelibrarytostudy,clean/organizemyroom,eatbreakfast,takevitamins,callafriend,gotoacoffeeshop,doachore.


2(SatorSun)

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MaintaininganAnxiousState

Yourtaskistobeacuriousinvestigatororscientistinthestudyofyouforatleasttwodaysthisweek.Whatareyourthoughtandbehaviorpatternsthatperpetuateyouranxiety?Whatperpetuatesfeelingokayorgood?Whatisnotworkingandwhatisworking?ThingsIthinkanddothatmaintainmyanxiousstate:Examplesofthoughts:Catastrophizing,disqualifyingthepositive,blackandwhitethinking.Examplesofbehaviors:Cancelingplanswithfriends,avoidinglargegatherings,skipclass.


2(SatorSun)

ThingsIthinkanddothathelpmefeelokay,calm,and/oraccomplished:Examplesofthoughts:Talkbacktoyournegativethoughts,remindyourselfthatspendingtimewithyourfriendsmakesyoufeelbetter.Examplesofbehaviors:Utilizeadeepbreathingtechnique,practice5,4,3,2,1grounding,exercise,spendtimewithfriendsdoinganenjoyableactivity.


2(SatorSun)

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SESSION5:Alternative

Responses

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RelaxationTechnique:GuidedImagery

Close your eyes and imagine your restful place. Picture it as vividly as you can: everything you see, hear, smell, taste, and feel. Just “looking” at it in your mind’s eye like you would a photograph is not enough. Visualization works best if you incorporate as many sensory details as possible. For example, if you are thinking about a dock on a quiet lake:

• See the sun setting over the water • Hear the birds singing • Smell the pine trees • Feel the cool water on your bare feet • Taste the fresh, clean air

Enjoy the feeling of your worries drifting away as you slowly explore your restful place. When you are ready, gently open your eyes and come back to the present. Don’t worry if you sometimes zone out or lose track of where you are during a visualization session. This is normal. You may also experience feelings of heaviness in your limbs, muscle twitches, or yawning. Again, these are normal responses.

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IdentifyingTriggersWorksheet

Whileattimesitmaybedifficulttoidentifyatrigger,understandingyourtriggersforanxietyisanimportantstepinhelpingyouknowwhentoimplementand/oremphasizepracticeofthecopingstrategiesyouwilllearninAnxietyToolbox.Triggerscanbeexternalevents(e.g.,atest)orinternalstimuli(e.g.,aphysicalsensationoremotion)thatledtoyourexperienceofanxiety(i.e.,theemotional,physical,cognitive,andbehavioralsymptomspreviouslydiscussedduringthisworkshop).Rememberthatsometimesthesymptomsthemselvescanbeatriggerthatstartsthecycleofanxiety.Thefollowingaresometypicalcategoriesinwhichtriggersmightappearwithexamples:ResponsestoInternalStimuli:• Emotions:e.g.,feelingdown,fearorworry• MentalImages:e.g.,replayinginterpersonalinteractionsorperformanceexperience• PhysicalState:e.g.,racingheartbeat,lightheadedness,tightnessinchest• Thoughts:e.g.,“Imightfailthistest”,“Thatpersonmustnotlikeme”,“Ifsomeonetalks

tomeinclass,Iwon’tbeabletohandleit.”ResponsestoExternalStimuli:• PresenceofOthers:e.g.,attendingasocialevent,meetingwithaprofessor,spending

timewithroommates,familyinteractions• PhysicalSetting:e.g.,aclassroom,openareasoncampus,insideacar• SocialPressure:e.g.,feelingpressuredtomakefriends,feelingpressuredtoperform

wellinschool(incomparisontoyourpeers)• Activities:e.g.,asportsevent,aparty,goinghomefortheweekendListsometriggersyouexperiencerelatedtoyouranxiety:

1._______________________________________________________________________________________________

2._______________________________________________________________________________________________

3._______________________________________________________________________________________________

4._______________________________________________________________________________________________

5._______________________________________________________________________________________________

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Self-AffirmationsThischeatsheetshouldhelpyoucreateself-affirmationsthatareeffectiveandpersonalized.Affirmationscanfocusonseveralcategories,includingcharactertraits,physicalattributes,andskillsand/oraccomplishments.

1. Startyouraffirmationswith“Iam”(e.g.,“Iamagoodfriend”)2. Keepthemshort(wedon’tneedanovel)3. Keepthempositive(avoidsaying“not”)4. Usefeelingwordswhenyoucan(e.g.,“Iamproudofmyself”)5. Keepthemfocusedonyou(afterall,theyareself-affirmations)

Examples:“IamproudthatIamhard-working”or“Iamthankfulformystronglegs”

MySelf-Affirmations:

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Feelingstuck?Askyourselfquestionslikethese:

• Whenwasatimethatyoufeltproudofyourselfandwhy?• Haveyoueverforgivensomeonewhohashurtyou?• Haveyoueverreceivedacomplimentthatyouagreewith?• Whatwouldyourbestfriendoralovedonesayaboutyou?

FeelingGuilty?Considerthis:

• Wearesocializedtoignoreorminimizeourpositivecharacteristics.• Unfortunately,wethenjustdwellonour“negatives.”• Practicingself-affirmationshelpsbringbalanceandimprovemood.

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AlternativeResponseWorksheet

Situation:(When?Where?What?Withwhom?Whatdidyoufeelanxious/depressedabout?)

Astudentinvitedmetoapartyinmyresidencehall,butIdidn’tknowherverywellandfeltanxiousaboutgoing.AlternativeThoughtsandImages:(Arethesethoughtshelpful?Aretheanxious/depressedthoughts100%true/accurate,100%ofthetime?Whatareotherwaysoflookingatthis?Whatisthebiggerpicture?)ImaynotbeassociallyawkwardasIthink.Ifsheinvitedme,sheprobablywantsmethere.ImightstillhaveanokaytimeevenifIamanxious

AlternativeBehaviors:(Whatcouldyoudothatwouldbemorehelpfulforyou,others,&/orthesituation?Whatarecopingstrategiesthatmightbehelpful?)CopingStrategiesICanUse:

q Deepbreathingq Distractmyselfq Seeksupportfroma

friend/familymember

q Doapleasurableactivity

q Usealternativeresponseworksheet

AlternativeFeelings:(Whatarefeelingsthataremorehelpful?Whatifyouactedandthoughtdifferentlyaboutthesituation?Howmightthesechangeshelpyoufeeldifferently?)Excited

Wanted

Liked

Hopeful

OriginalOutcome:(Whatwastheoriginaloutcome?)IstayedinmyroomandwatchedNetflix.

DesiredOutcome:(Usingthesenewalternatives,whatwouldyouliketheoutcometobeinthefuture?)IwanttogotothepartysothatIcanmakefriends.IfIfeeltoouncomfortable,Icanalwaysleave.

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AlternativeResponseWorksheetSituation(When?Where?What?Withwhom?Whatdidyoufeelanxious/depressedabout?)Ihaveagroupassignmentdueformyclass.Iaskedafellowclassmatetobemypartner,butshedeclined.AlternativeThoughtsandImages:(Arethesethoughtshelpful?Aretheanxious/depressedthoughts100%true/accurate,100%ofthetime?Whatareotherwaysoflookingatthis?Whatisthebiggerpicture?)Shemightalreadyhaveapartner.I’vedonewellinthisclasssofar,soImightnotbestupid.Noteveryoneisgoingtolikemeandthatisokay.



friend/familymember



AlternativeFeelings:(Whatarefeelingsthataremorehelpful?Whatifyouactedandthoughtdifferentlyaboutthesituation?Howmightthesechangeshelpyoufeeldifferently?)ContentCalmReassured

OriginalOutcome:(Whatwastheoriginaloutcome?)Ifeelstupid,Idon’tjoinagroupandwaitfortheprofessortoassignmeone.Idon’tworkontheprojectbecauseIamembarrassedthatprofessorhadtoassignmeintoagroup.

DesiredOutcome:(Usingthesenewalternatives,whatwouldyouliketheoutcometobeinthefuture?)Iamabletofeelreassuredandfindanothergrouptojoin.Icompletetheprojectanddowellonit.

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AlternativeResponseWorksheetSituation(When?Where?What?Withwhom?Whatdidyoufeelanxious/depressedabout?)AlternativeThoughtsandImages:(Arethesethoughtshelpful?Aretheanxious/depressedthoughts100%true/accurate,100%ofthetime?Whatareotherwaysoflookingatthis?Whatisthebiggerpicture?)



friend/familymember



AlternativeFeelings:(Whatarefeelingsthataremorehelpful?Whatifyouactedandthoughtdifferentlyaboutthesituation?Howmightthesechangeshelpyoufeeldifferently?)

OriginalOutcome:(Whatwastheoriginaloutcome?)

DesiredOutcome:(Usingthesenewalternatives,whatwouldyouliketheoutcometobeinthefuture?)

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Ifyou'rehavingtrouble,askyourselfthesequestions:Wheneverwerecognizeananxiety-relatedthought,feelingorbehavior,itcanbeveryhelpfultoaskourselvesthefollowingquestions:AlternativeTHOUGHTS:1. Whatareotherwaysoflookingatthissituation?2. AmIlookingatthewholepicture?3. Whatmightbeamorehelpfulwayofpicturingthissituation?4. WhatunhelpfulthinkingstylesmightIbeusinghere(seebelow)?5. Whatistheevidencethatmythoughtsaretrue?Isthereanalternativewayofthinking

aboutthissituationthatismoretrue?6. Whatistheprobabilitythatmythoughtswillhappen?Whataresomeotherthingsthat

couldhappenthatareequally,ifnotmore,probable?7. HaveIhadanyexperiencesinthepastthatsuggeststhatthisthoughtmightnotbe

COMPLETELYtrueALLofthetime?8. CanIreallypredictthefuture?Isithelpfultotry?Whatismorehelpful?9. AmIexaggeratinghowbadtheresultmightbe?Whatismorerealistic?10. CanIreadpeople’sminds?Whatelsemighttheybethinking(that’snotsonegative)?11. Ifafriendorlovedonewereinthissituationandhadthisthought,whatwouldItell

them?CommonCognitiveDistortions(UnhelpfulThinkingStyles)

AllorNothingThinking:thinkinginabsolute,blackandwhitecategories

Over-generalizing:seeingapatternbaseduponasingleeventorbeingoverlybroadinconclusionswedraw

MentalFilter:onlypayingattentiontocertaintypesofevidence(e.g.,dwellingonthenegatives)

Disqualifyingthepositive:discountingthegoodthingsthathavehappened

JumpingtoConclusions:Mindreading:imaginingweknowwhatothersarethinkingFortunetelling:predictingthefuture

Magnification(catastrophizing)andminimization:blowingthingsoutofproportionorinappropriatelyshrinkingsomethingtomakeitseemlessimportant

EmotionalReasoning:assumingbecausewefeelacertainway,whatwethinkmustbetrue

Should/MustThinking:Usingwordslike“should”,“must”,“oughtto”or“haveto”

Labeling:assigninglabelstoourselvesorothers

Personalization:blamingyourselfforsomethingyouweren’tentirelyresponsibleforORblamingothersandoverlookingwaysyoumayhavecontributedtotheoutcome

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AlternativeBEHAVIORS:1. WhatcouldIdointhemomentthatwouldbemorehelpful?2. What’sthebestthingtodo(forme,forothers,orforthesituation)?3. Ifmyfearedsituationhappens,howwillIcope?WhatcopingskillscanIusetohandle

myfearedsituation?WhathaveIdoneinthepastthatwassuccessful?4. AmIneedingtoworkonacceptance,lettinggoofcontrol,beingokaywithlessthan

perfect,orhavingfaithinthefutureandmyself?5. Breathe:Focusyourattentiononyourbreathing.Imagineyouhaveaballooninyour

belly,inflatingonthein-breath,deflatingontheout-breath.AlternativeFEELINGS:1. WhatmightitfeellikeifIacted/thoughtdifferently?2. WhenI’mnotfeelingthisway,doIthinkaboutthissituationdifferently?3. ArethereanystrengthsorpositivesinmeorthesituationthatImightbeignoring?4. Whatelsemightthisanxietyberelatedto?Isitreallyaboutfeeling_______?5. Tellyourself:“Thisfeelingwillpass.It’sanormalbodyreaction.”

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OtherHelpfulThoughtTips

1. Stopping.Interruptathoughtasitbegins.Useastrongimageorawordtointerruptthethought.Stronglystateit,eitherinternallyoraloud.

2. Distracting.Redirectyourmindtosomethingelseinternallyorexternally,preferablysomethingpleasantandengaging.

3. MindfulObserving.Watch,label,orlogyourthoughts.Usethelanguage“Iamthinking…”or“My

mindishavingthethoughtthat…”todistanceyourselffromthethought.

4. Understanding.Begintounderstandwherethoughtscomefrombyaskinganumberofquestions,including:Whatisthepurposeofthisthought?Doesittietoaspecificschema?

5. MindfullyLettingGo.Useimageryorwordstovisualizethoughtspassingby.Goodexamplesarecloudsintheskyorleavesonastream.

6. Gratitude.Trytofocusonsomethingthatyouaregratefulforfromthepast,present,orfuture.

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PuttingitallTogether:MyPlanforManagingAnxiety/Depression

1. Myprimaryanxiety/depressivesymptomsinclude:[pg.23,24]

a. Emotional:

b. Physical:

c. Cognitive:

d. Behavioral:

2. Someofmyunhelpfulwaysofthinkingare:(e.g.,allornothingthinking,catastrophizing,etc.)[pg.34]

3. Someofmyunhelpfulbehaviorsare:(e.g.,isolating,stayinginbed)[pg.35,39,40]

4. Mysituationalandcognitivetriggersare:(e.g.,unfamiliarsituations,negativethoughts,etc.)[pg.43]

5. Themosthelpfulrelaxationtechniquesare:[pgs.8,9,16,22,33,42,57,58]6. Thebesttimeandplacetopracticerelaxationexercises:

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7. OnesleepandoneexercisetoolIplantouse:[pgs.17,19]8. TwothoughtexercisesIplantouseare:(e.g.,alternativeresponses(whatspecific

questionsfrompage47),self-affirmations)[27,44,47,48,50]

9. MYGOALS:Name2goalsyouwouldliketoachieveoverthenextfewmonths,relatedtodepression/anxietyandself-care.Think:specific,achievable,andmeasurable.a. Name2goalsyouwouldliketoachieverelatedtoANXIETY/DEPRESSION(e.g.,

Thinkingaboutthestrategiesyoufindmosthelpful,whatwouldyouliketotry,howoften,when,etc.?)

i. ______________________________________________________________________

ii. ______________________________________________________________________

b. Name2goalsyouwouldliketoachieverelatedtoSELF-CARE:(Whatwillyourself-carelooklikeoverthenextfewmonths?Thesecouldbegoalsrelatedtonutrition,exercise,sleep,schoolwork,leisureactivities,etc.)[pg.17,19,20,55,56]

i. _______________________________________________________________________

ii. ________________________________________________________________________

10. Reminderaboutplanandgoals:

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

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APPENDIX

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OnlineResources

MayoClinicStressReductionWebsitehttp://www.mayoclinic.com/health/mindfulness-exercises/MY02124MeditationOasiswww.meditationoasis.comMindfulwww.mindful.orgMindfulnessResearchGuidehttp://www.mindfulexperience.org/UCLAMindfulAwarenessResearchCenter-GuidedMedicationshttp://marc.ucla.edu/body.cfm?id=22

AppsforyourSmartphone,Tablet,orComputerACTCoachBreathe2relaxBreathingtechniquesbyHemalayaaCBTi-CoachMindfulnessCoachMindshiftT2MoodTrackerTakeabreak!

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HelpfulBehavioralTipsThefollowinglistsofideasaremeanttogetyouthinkingaboutpossibilitiesforhelpfulbehaviors.Theactivitiesdonothavetobehugecommitments;focusonsmallbabysteps.Chooseactivitiesthataredo-ableforyouwhenyouarefeelingdown.Themoresuccessyouhaveindoingthelittlethings,themorelikelyyouwillbemotivatedtotrymorethings.IdeasforSocializing

� Watchamoviewithafriend � Gotoagymclass,danceclass,martialartsclass,etc.

� GotoanintramuralorCPgame � GoeatfreesamplesatFarmer’sMarket

� Gotothelibrary,UU,ordormloungetostudy

� Plantoeatamealwitharoommate/friend

� _____________________________ � _____________________________

IdeasforPleasantActivities

� Playwithapet � Color/Paint/Draw/Sculpt

� Goshoppingorwindowshopping � Writeapoem,music,play,story

� Fix/tinkerwithsomething � Readforfun

� Listentomusic � Watchthesunset/riseatthebeach

� ______________________________ � _______________________________

IdeasforMasteryActivities

� Washadishortwo(eveniftheyaren’tyours)

� Readachapterorapageofyourhomeworkassignment

� Dolaundry � Takeoutthetrash

� Returnaphonecall � Payabill

� Writethatemailtoyourprofessor

� _____________________________

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OtherHelpfulBehavioralTipsforManagingDepression

1. Getsunlight:Aimfor5to15minutesofsunlightaday.Sunlightincreasesthebrain’sreleaseofserotonin,whichisassociatedwithboostingmood.

2. Getamassage:Massageboostsserotoninanddecreasesstresshormones.Trygivingyourselfamassagebylyingonorleaningagainstatennisballorrollingitagainstyourmuscles.

3. PracticeYoga:Yogaworkstoimprovemoodandhasbenefitssimilartothatofexerciseandrelaxationtechniques.

Yogaposesthatincorporatebackbendsandopeningthechesthelptoincreasepositiveemotions.

4. Standupstraight:Yourbodytellsyourbrainhowtofeel.Standupstraightandopenyourchesttofeelmoreconfident.

5. Smile(evenifyou’refaking):Whenyousmile,youaremorelikelytoperceivepositiveemotionsinotherpeople,whichcanpositivelyimpactyourmood.

Smilingwillleadyourbraintobelievethatyouarehappy.

6. Laugh(evenifyou’refaking):Yourbraindoesnotdistinguish

betweenrealandfakelaughter.Ifyourbraingetssignalsfromyourbodythatyoushouldfeelhappy,

thenitismorelikelytofeelhappy.7. DoProgressiveMuscle

Relaxation:Flexatightmuscleforafewsecondsandrelease.Payparticularattentiontoyourfacialmusclesasthosehavethelargesteffectonemotion.

8. Create/listentomusic:Musiccanhelpregulateyouremotions.Itcanbesoothingandhelpyoufeelcalmand/oritcanbeenergizingandpumpyouup.

9. Dance:Dancingcombinesmusicandphysicalactivitysoitisadoublewhammy.

10. Journal:Labelingyouremotionsandwritingyourstorycanbecatharticandhelpyouorganizeyourthoughts.

AdaptedfromAlexKorb’s“TheUpwardSpiral”

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GroundingExercisesWhenpeoplebecomeoverwhelmedwithdistressingthoughtsorfeelings,includingintenseanxiety,activitiesthatkeepyourmindandbodyconnected(called“grounding”)canbehelpfulinregainingasenseofstabilityandmentalfocus.Thefollowingareanumberofgroundingexercisestochoosefromtohelpfirmlyanchoryouinthepresentmomentandprovideyouwithspacetochoosewheretofocusyourenergy.Youmayneedtotrymultipledifferentexercisestofindoneortwothatworkbestforyou.1. Remindyourselfofwhoyouarenow.Stateyourname,ageandwhereyouareright

now.

2. Taketenslowdeepbreaths.Focusyourattentiononeachbreathonthewayinandonthewayout.Saythenumberofthebreathtoyourselfasyouexhale.

3. Splashwateronyourfaceorplaceacoolwetclothonyourface.

4. Paypurposefulattentionasyouholdacold(non-alcoholic)beverageinyourhands.Feelthecoldness,andthewetnessontheoutside.Notethetasteasyoudrink.Youcanalsodothisexercisewithawarmbeverage.

5. Finda“groundingobject”tohold,lookat,listento,and/orsmell.Thiscouldbeasoftobjectsuchasapilloworstuffedanimal,asmoothstoneyoufoundonthebeach,apictureofabeautifulsceneorlovedone,and/oranyotherobjectthatrepresentssafetyorcomfort.

6. Listentomusic.Paycloseattentionandlistenforsomethingnewordifferent.

7. Ifyouwakeupsuddenlyduringthenightandfeeldisorientedordistressed,remindyourselfwhoyouareandwhereyouare.Lookaroundtheroomandnoticefamiliarobjectsandnamethem.Feelthebedyouarelyingon,thesoftnessofthesheetsorblankets,thewarmthorcoldnessoftheair,andnoticeanysoundsyouhear.Remindyourselfthatyouaresafe.

8. Feeltheclothesonyourbody,whetheryourarmsandlegsarecoveredornot,andthesensationofyourclothesasyoumoveinthem.

9. Whilesitting,feelthechairunderyouandtheweightofyourbodyandlegspressingdownonit.

10. Ifyouarelyingdown,feelthecontactbetweenyourhead,yourbodyandyourlegs,astheytouchthesurfaceyouarelyingon.Startingfromyourhead,noticehoweachpartfeels,allthewaydowntoyourfeet,onthesoftorhardsurface.

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11. Stop,look,andlisten.Noticeandnamewhatyoucanseeandhearnearbyandinthedistance.

12. Lookaroundyou,noticewhatisfrontofyouandtoeachside,namefirstlargeobjectsandthensmallerones.

13. Getup,walkaround,takeyourtimetonoticeeachstepasyoutakeonethenanother.

14. Ifyoucan,stepoutside,noticethetemperature,thesoundsaroundyou,thegroundunderyourfeet,thesmellintheair,etc.

15. “54321”GroundingExercise:o Name5thingsyoucanseeintheroomwithyou.o Name4thingsyoucanfeel(tactile;e.g.“chaironmyback”or“feetonfloor”)o Name3thingsyoucanhearrightnowo Name2thingsyoucansmellrightnowo Name1goodthingaboutyourself

16. Writeand/orsaygroundingstatementso Thissituationwon’tlastforevero Thistooshallpass.o Icanridethisoutandnotletitgetmedown.o Myanxiety/fear/sadnesswon’tkillme;itjustdoesn’tfeelgoodrightnow.o Thesearejustmyfeelingsandeventuallythey’llgoaway.

Adaptedfrom:http://www.livingwell.org.au/well-being/grounding-exercises/

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Physical(Whenanxious,whatphysicalsensationsdidyouexperience?Whatdidyounoticeinyourbody?)

Cognitive(Whatwentthroughyourmindwhenyoufeltanxious?Whatdidthatsayormeanaboutyouorthesituation?)


Emotional(Whatemotionscameupforyouwhenyoufeltanxious?)


Situation(When?Where?What?Withwhom?Whatdidyoufeelanxiousabout?)

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Situation(When?Where?What?Withwhom?Whatdidyoufeelanxiousabout?)

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CrossSectionalFormulation Situation(When?Where?What?Withwhom?Whatdidyoufeelanxiousabout?)

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friend/familymember






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friend/familymember






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friend/familymember






Documents

Anxiety & Depression Student Workbook · 2020-04-21 · Page 3 CAPS Getting Unstuck Workbook (479) 575-5276 (24/7) Health.uark.edu Welcome! Welcome to Anxiety and Depression Reduction