PEACEFUL LIVINGWORKBOOK

Workbook 1

Becoming Aware of your Anxiety

ORIENTATION TO THE PEACEFUL LIVING PROJECTThe goal of the Peaceful Living meetings is to help you become more aware of your anxiety symptoms and to learn new skills to cope with anxiety. The meetings will be once a week in person or over the phone (after the second session) with each session lasting 30 minutes. Telephone follow-up calls will occur a few days after each session, for approximately 10-15 minutes. Discussion in meetings will focus on anxiety, with and without depression, and calming skills to help manage anxiety. To benefit from these meetings, it is important to practice the new skills each day. At the end of each meeting, you will be given practice exercises to complete during the week.

ASSESSING YOUR MOTIVATION FOR CHANGEIn your own words, what are your most significant reasons for seeking help with anxiety?

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

PROS AND CONS OF CHANGE

PROS (OR BENEFITS) OF CHANGE: CONS (OR COSTS) OF CHANGE:

1. Generally function better – live a more 1. Takes time to practice the skills.fulfilled life.

2. Make it easier to cope with symptoms of 2. Facing anxiety symptoms can be difficult anxiety. and may temporarily increase anxiety

or depression

3. _________________________________ 3. _______________________________

4. _________________________________ 4. _______________________________

5.__________________________________ 5. _______________________________

Workbook 2

MOTIVATION FOR CHANGEAttending meetings and practicing skills takes time, energy, and focus. If you start to lose motivation for participating in the program, try focusing on the benefits you could achieve by referring back to this worksheet.

Only YOU can decide if the benefits are worth your time and effort.

LIFE VALUES & GOALSExamples: family/friend relationships, health and fitness, spirituality, work satisfaction, recreation and hobbies, financial security

LIFE VALUES GOALS

Workbook 3

MY EXPERIENCE OF ANXIETY

1. Physical Signs: How your body reacts to anxiety.

_____Muscle tension _____Shaking/Trembling

_____Rapid pulse _____Sweating

Shortness of breath _____Butterflies in stomach

_____Other:

2. Thoughts or Worries: What is running through your mind, including worries and concerns.

_____Health (own and others’) _____Family/friends

_____Finances _____Daily events

_____Issues related to aging _____ Work/ volunteer/ church Activities

_____Other:

3. Behaviors: Actions you take to reduce anxiety, such as avoiding feared situations or doing something over and over.

Avoidance:_____Not making decisions _____Procrastination

_____Avoidance of activities _____ Ignoring

_____Other:

Doing too much: _____Checking _____Snacking

_____Smoking _____Cleaning

_____Other:

Workbook 4

HOW TO REDUCE ANXIETY

STEP 1: BECOMING AWARE OF YOUR ANXIETY It is important to learn to identify the situations, physical signs, thoughts, and actions that are associated with your anxiety so you can begin to experience more Peaceful Living. The earlier you are able to recognize anxiety, the easier it is to control.

STEP 2: LEARN AND PRACTICE NEW CALMING SKILLSYou will learn many new skills that will give you a “toolbox” of skills from which to choose. You must PRACTICE the skills in order for them to help you.

AWARENESS PRACTICE EXERCISE EXAMPLE

What situation created stress today?

__________________________________________________________________________ Where were you? Who were you with?

__________________________________________________________________________

What feelings did you have? What physical signs did you have?[ ]anxiety [ ]fearful [ ]muscle tension [ ]shaking/trembling

[ ]worried, nervous [ ]anger [ ]rapid pulse [ ]sweating[ ]embarrassed [ ]sadness [ ]shortness of breath [ ]other:___________[ ]other:_ ________ [ ]butterflies in stomach

What thoughts/worries did you have?___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

What actions did you DO or NOT DO to reduce anxiety?___________________________________________________________________________

___________________________________________________________________________

Workbook 5

Becoming Aware of Your Anxiety

Instructions for Practice Exercises

Remember: The more you PRACTICE the better you’ll be at reducing and managing your anxiety.

Practice times: Choose a regular time when you can spend 10 to 15 minutes a day completing practice exercises.

When could your practice time be? _______________

Awareness Training: Think of a recent situation that made you anxious. Use the Practice Exercise form to record the situation and associated feelings, physical signs, thoughts, and actions.

Workbook 6

Becoming Aware of Your AnxietyPractice Exercises

Date__________ Time_______am/pmDay__________

What situation created stress today?

__________________________________________________________________________

Where were you? Who were you with?

__________________________________________________________________________

What feelings did you have? What physical signs did you have?[ ]anxiety [ ]fearful [ ]muscle tension [ ]shaking/trembling

[ ]worried, nervous [ ]anger [ ]rapid pulse [ ]sweating[ ]embarrassed [ ]sadness [ ]shortness of breath [ ]other:___________[ ]other:_ ________ [ ]butterflies in stomach

What thoughts/worries did you have?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

What actions did you DO or NOT DO to reduce anxiety?___________________________________________________________________________

___________________________________________________________________________

Workbook 7

DEVELOPING YOUR PEACEUL LIVING PROGRAM

These meetings will cover a selection of topics depending upon your most important problems and current goals. Everyone will learn three basic skills (or tools) and additional skills. It is more important to learn the skills that are tailored to your individual needs than to breeze through many topics, some of which may not directly apply to you. Some topics can be covered over the telephone. You and your counselor will decide if using the telephone to learn skills is the best option for you.

In the following week, think about which topics could help you achieve your goals and experience more Peaceful Living.

TOPIC OVERVIEWAnxiety Education and Becoming Aware of Anxiety*

Learn about anxiety and become aware of your own physical signs, feelings, thoughts, and actions.

Learn How to Relax I* Reduce anxiety with slow, deep breathing.

Changing Your Thoughts to Manage Anxiety I*

Manage your anxiety by using calming and reinforcing self-statements.

Changing Your Behaviorfor Depression (Parts 1 & 2)

Break the downward spiral of depression by getting involved in activities you may avoid because of sad mood.

Changing Your Behavior for Anxiety (Parts 1 & 2)

Stop engaging in repetitive behaviors and get involved in activities you may avoid because of anxiety.

Getting to Sleep Learn about things you can do during daytime and nighttime to manage difficulties in sleep.

Problem Solving Solve problems through effective steps. This is useful for people who worry about problems or have trouble finding solutions to problems.

Learn How to Relax II(Parts 1 & 2)

Pinpoint and release muscle tension using a procedure called Progressive Muscle Relaxation.

Changing Your Thoughts to Manage Anxiety II(Parts 1 & 2)

Stop dwelling on anxiety-related thoughts and images and challenge negative thoughts by replacing them with more realistic alternative thoughts.

Maintaining a Peaceful Life* Review your progress and develop a plan to continue Peaceful Living.

*Skills that everyone will receive.

Workbook 8

Learn How to Relax

DEEP BREATHINGPhysical signs of anxiety, such as muscle tension, sweating and trembling, can be reduced with relaxation exercises. Relaxation exercises not only target the physical signs of anxiety, but can also ease racing thoughts and decrease feelings of fear and anxiety. The purpose of relaxation exercises is to teach your body to be in a physically relaxed state instead of feeling afraid or anxious. For example, can your heart beat fast and slow at the same time? No, just like you cannot be anxious and relaxed at the same time.

One way to make your entire body more “relaxed” is deep breathing. Often when you’re anxious, your breathing gets rapid and shallow. Rapid and shallow breaths can lead you to hyperventilate or feel dizzy and lightheaded. Experiencing these physical signs is stressful and can cause you to feel anxious, which in turn can increase the physical signs of anxiety.

Attending to your breathing and changing the rate and way you breath can actually make your entire body more “relaxed.”

TWO KEY FEATURES of DEEP BREATHING:

1. Take slow, even, deep breaths . Inhale through your nose to the count of 5 and exhale through your mouth to the count of 5. Do not pause at the top of each breath.

2. Breathe through your diaphragm, not your chest . Place one hand on your stomach, with your little finger about 1 inch from your navel, and the other hand on your chest. Make sure the hand on your stomach is moving in and out as you breathe, and the hand on your chest is staying still.

Workbook 9

Learn How to Relax

Instructions for Practice ExercisesChanging your experience of anxiety is like learning any new skill. Just like learning to ride a bike or play an instrument, it gets easier with practice!

Practice Times: Choose a regular time to practice each day for 10-15 minutes. When could your practice time be?______________

Continue Awareness Training: Continue to identify anxiety producing situations and write down associated feelings, physical signs, thoughts and behaviors..

Relaxation Training: Practice deep breathing during your practice time to learn this new skill. Then, try to use deep breathing in anxiety producing situations throughout the week to help you relax. Record on your form whether your new skill helped. Remember, the more you practice, the easier it will be to use this tool.

For Next Session: Think about the elective skills that were recommended for you, as well as the others on the list. Number the skills you’ve chosen in order of importance or what you feel would be most beneficial to you. Your counselor will be able to help you decide on how many electives you will be able to cover during treatment.

SELECTING YOUR MEETING TOPICSTo be determined by Session 3.

Anxiety Education and Becoming Aware of Your Anxiety*Learn How to Relax I*Changing Your Thoughts to Manage Anxiety I*

Changing Your Behavior for Depression (Parts 1 & 2) Changing Your Behavior for Anxiety (Parts 1 & 2) Getting to Sleep Problem Solving Learn How to Relax II (Parts 1 & 2) Changing Your Thoughts to Manage Anxiety II (Parts 1 & 2)

Maintaining a Peaceful Life**Denotes skills that everyone will receive

Workbook 10

Date ___________ Time _______am/pm Day ___________

Learn How to RelaxPractice Exercises

What situation created stress today?

__________________________________________________________________________

Where were you? Who were you with?

__________________________________________________________________________

What feelings did you have? What physical signs did you have?[ ]anxiety [ ]fearful [ ]muscle tension [ ]shaking/trembling

[ ]worried, nervous [ ]anger [ ]rapid pulse [ ]sweating[ ]embarrassed [ ]sadness [ ]shortness of breath [ ]butterflies in [ ]other:_ ________ [ ]frustrated [ ]other:___________ stomach

What thoughts/worries did you have?

___________________________________________________________________________

___________________________________________________________________________

__________________________________________________________________________

What actions did you DO or NOT DO to reduce anxiety?___________________________________________________________________________

___________________________________________________________________________

RELAXATION PRACTICE

Did you practice deep breathing today? [ ] YES [ ] NODid you use deep breathing in a real life situation today? [ ] YES [ ] NO

Workbook 11

If yes, did it help you to relax? [ ] YES [ ] NO

Changing Your Thoughts to Manage Anxiety

CALMING THOUGHTSA calming thought is a statement that you make to yourself that helps to decrease anxiety. It is a way to provide “instructions” to yourself about how to manage anxiety and reduce how much it gets in the way. This type of self-talk can help you realize that some situations aren’t as bad as you expect them to be – and that you can manage your anxiety better than you thought.

Examples of CALMING THOUGHTS

1. Preparing for an anxiety producing situation : I can do what I need to do. I can develop a plan to deal with this situation. I can manage this situation. It will be ok once I get started. Don’t worry – worry won’t help anything.

2. Facing an anxiety-producing stressor : If I take it one step at a time, I can meet this challenge. Don’t think about fear, just about what I have to do. I can continue working even if I feel anxious. Even if I make mistakes, it will be ok. Keep the focus on the present. What is it I have to do?

3. Feeling overwhelmed : When the anxiety comes, take a step back and think. Let me monitor my anxiety from 1 to 5 and watch it change. It’s not the worst thing in the world. Don’t avoid. This is an opportunity to cope with my anxiety. I can do what I have to do in spite of my anxiety. My anxiety won’t hurt me. Relax, take a deep breath.

Workbook 12

CALMING THOUGHTS THAT I COULD USE:

______________________________________________________

______________________________________________________

______________________________________________________

Examples of REINFORCING THOUGHTS

It worked! I was able to do it. It wasn’t as bad as I had expected. I made too much out of the situation. I was able to manage my anxiety. This experience will help me in the future. It’s getting easier each time I practice these

techniques. I can learn to cope with my anxiety.

REINFORCING THOUGHTS THAT I LIKE:

_________________________________________________

_________________________________________________

TIPS FOR USE OF SELF-STATEMENTS: Don’t be afraid to talk to yourself out loud! Saying calming thoughts to yourself instead

of just reading them can often be more effective and convincing. It can sometimes be helpful to record the thoughts on tape and listen to the tape when

necessary. Write your favorite one on a small note card and carry it in your wallet or post it some

place where you can recite it often (e.g. on a mirror or refrigerator).

Changing Your Thoughts to Manage Anxiety

Workbook 13

Instructions for Practice Exercises

Continue awareness training: Continue to identify anxiety producing situations and write down associated feelings, physical signs, thoughts, and behaviors.

Continue to use breathing skills: Record “yes” or “no” whether or not you used breathing skills and whether or not these skills were helpful.

Practice using calming thoughts: Select a calming thought that could be helpful in the situation and write it down on the form provided.

If I take it one stepat a time, I can meet this challenge...

Workbook 14

Changing Your Thoughts to Manage AnxietyPractice Exercises

Date ___________ Time _______am/pm Day ___________

What situation created stress today?

__________________________________________________________________________

Where were you? Who were you with?

__________________________________________________________________________

What feelings did you have? What physical signs did you have?[ ]anxiety [ ]fearful [ ]muscle tension [ ]shaking/trembling

[ ]worried, nervous [ ]anger [ ]rapid pulse [ ]sweating[ ]embarrassed [ ]sadness [ ]shortness of breath [ ]other:__________[ ]other:_ ________ [ ]butterflies in stomach

What thoughts/worries did you have?

___________________________________________________________________________

___________________________________________________________________________

What actions did you DO or NOT DO to reduce anxiety?___________________________________________________________________________

___________________________________________________________________________

RELAXATION PRACTICEDid you use breathing skills today? [ ] YES [ ] NOIf so, did it make you more relaxed? [ ] YES [ ] NO

SELF-STATEMENTSDid you use calming thoughts in a real life situation today? [ ] YES [ ] NOIf yes, write the self-statement you used today: ___________________________________________________________________________

Workbook 15

Was the calming thought helpful? [ ] YES [ ] NO Changing Your Behavior for Depression

Part One

As depression sets in, you may not feel like being around others and may find yourself spending less time with friends and family. If the cycle continues, you may stop doing pleasant activities you usually enjoy and find yourself feeling more and more depressed.

These pictures show how mood and behavior are connected through a cycle. Not engaging in activities that are pleasurable tends to lower mood even further, which, in turn, continues to decrease your activity level.

Depressed Mood and Symptoms

Pleasant Activities

Decreased Activity

Lowered Mood

Decreased Pleasant Activities

Better Mood and Fewer Depressive Symptoms

If you are feeling depressed, increasing pleasant or productive activities on a daily basis can help to improve your mood and decrease symptoms of depression.

Improved MoodDecreased Depressive Symptoms

Workbook 16

Pros and Cons of Adding Activites to Your Life

PROS (OR BENEFITS):

1. ________________________________________________________________

2. ________________________________________________________________

3. ________________________________________________________________

4. ________________________________________________________________

CONS (OR COSTS):

1. ________________________________________________________________

2. ________________________________________________________________

3. ________________________________________________________________

Workbook 17

4. ________________________________________________________________

Recording Daily Activities and Rating your Mood

In order to help you better understand your current mood and activity level, complete the following form for a recent “typical day” (possibly today or yesterday). This will help you see what activities may fit in your day and ultimately, help improve your mood.

Daily Activities List and Mood RatingOn the table below, list your typical activities for each time period of the day. Rate your mood for each time period using the five-point scale. If you felt happy, use 4 (good) or 5 (very good). If you felt low or blue, mark 2 (bad) or 1 (very bad). Mark 3 (so-so) if your mood was somewhere in the middle. For each rating, indicate a possible reason you may have felt the way you did.

Activities Mood Reasons I Felt the Way I Did

Morning Activities1.

2.

Afternoon Activities3.

4.

Evening Activities5.

6.

Instructions for Practice ExercisesComplete the Daily Activities List and Mood Rating for at least 3 days.Continue to practice previously learned calming skills for anxiety.Date ___________ Time _______am/pm

Very Bad1

Bad2

So-So3

Good4

Very Good5

Workbook 18

Day ___________

Changing Your Behavior for DepressionPart One Practice Exercises: Daily Activities List and Mood Rating

Activities Mood Reasons I Felt the Way I Did

Morning Activities1.

2.

Afternoon Activities3.

4.

Evening Activities5.

6.

Did you use any other calming skills today? [ ] YES [ ] NO

If yes, which ones?_____________________________________________________

If yes, were they helpful? [ ] YES [ ] NO

Very Bad1

Bad2

So-So3

Good4

Very Good5

Workbook 19

Changing Your Behavior For DepressionPart Two

IDENTIFY PLEASANT EVENTS AND MEANINGFUL ACTIVITIESEach person has his or her own ideas about activities that are enjoyable or satisfying. Some activities involve social interaction with friends or family, while others may provide a sense of accomplishment.

1. Are there two or three things you are currently doing that give you pleasure or a feeling of satisfaction? Please list these pleasant activities in the table below. Examples include reading, taking walks, listening to music, visiting with a friend, playing a game, doing a favor for someone, cleaning the house, or cooking a meal.

Current Activities

2. Are there other things or activities you would like to do that you are not doing now? What would be enjoyable or give you a sense of accomplishment? This could be something you have enjoyed in the past, or something new you would like to try. List these ideas in the table below. Also think about what has kept you from doing these activities.

Activities Not Currently Doing What Interferes With Doing This?

Workbook 20

CHECKLIST OF LIFE ACTIVITIES OR EVENTS

EXCURSIONS/COMMUNITY SOCIAL ACTIVITIES AND INTERACTIONS WITH OTHERS

1. Going to the park or beach 1. Getting together with friends

2. Going out to dinner 2. Visiting a neighbor

3. Going to the library or a book store 3. Having family visit or visiting family 4. Going to the movies 4. Eating out with friends or associates

5. Going shopping 5. Going to a local community center

6. Going fishing 6. Playing bingo, majong, cards, dominos with others

HEALTH AND WELLNESS PHYSICAL ACTIVITY

1. Putting on makeup or perfume 1. Walking for exercise or pleasure

2. Eating healthier 2. Light housekeeping, such as sweeping

3. Relaxing, meditating or doing yoga 3. Swiming or doing water exercise

4. Improving one’s health 4. Gardening or planting

SPIRITUAL, RELIGIOUS, AND KIND ACTS

RECREATIONAL AND OTHER LEISURE ACTIVITIES

1. Going to a place of worship 1. Knitting, sewing or needlework

2. Attending a wedding, baptism, barmitzvah, religious ceremony or function

2. Writing in a journal or diary or keeping a scrapbook or photo album

3. Reading the bible 3. Playing with or having a pet

4. Attending a bible study group 4. Drawing, painting or crafts

5. Doing favors for others or volunteer 5. Singing or listening to music

6. Volunteering for a special cause 6. Reading the newspaper or magazines

7. Watching TV or listening to the radio

8. Doing word puzzles or play cards

Workbook 21

Adapted, with permission, from Lejuez, C.W., Hopko, D. R., & Hopko, S. D. (2001). A brief behavioral activation treatment for depression. Behavior Modification 25:255–286.

Changing Your Behavior For DepressionPart Two Continued

Choose 1 or 2 activities that are important to you at this time. They can be activities that you enjoy doing or things you want to accomplish. Make sure to choose activities that are not too difficult and can be broken down into small steps. Think about help you may need from others to complete each activity and be sure to include that in your steps.

Activity 1:

Activity 2:

ACTIVITY PLANNINGWe want to make sure to choose activities that are consistent with your life goals and values. Setting goals can help you to monitor change and progress over time. A guideline for setting goals is SMART.

Specific: What is the target for the goal? Who? What? Where?Measurable: How are you going to measure your success?Attainable: Is this a goal you feel confident that you can achieve?Relevant: How does this goal get you closer to a life goal, value or priority in your life?Timed: When is the goal to be completed? A week? A month?

Workbook 22

Changing Your Behavior For DepressionPart Two Practice Exercises: Activity Schedule Log

Instructions for Practice ExercisesComplete the planned activities for the next week and record progress on the Activity Schedule Log below. Remember, you may have to complete the activity several times before you notice a change in your mood. With each step you take towards completing the activity, it is more likely your mood will improve and your symptoms will decrease.

How likely are you to follow through with these steps in the next week?

1 2 3 4 5 6 7 8 9 10Not likely Very likely

Activity Completed: [ ] YES [ ] NO

Date Completed: ______________________________

Activity 1:________________________________________________________

________________________________________________________

Step 1: __________________________________________________Step 2: __________________________________________________Step 3: __________________________________________________Calming skills I can use or help I may need from someone else:________________________________________________________

________________________________________________________

DATE TO BE COMPLETED BY: ____________________________

Workbook 23

Changing Your Behavior For DepressionPart Two Practice Exercises: Activity Schedule Log Continued

How likely are you to follow through with these steps in the next week?

1 2 3 4 5 6 7 8 9 10Not likely Very likely

Activity Completed: [ ] YES [ ] NO

Date Completed: ______________________________

Activity 2:________________________________________________________

________________________________________________________

Step 1: __________________________________________________Step 2: __________________________________________________Step 3: __________________________________________________

Calming skills I can use or help I may need from someone else is:________________________________________________________

________________________________________________________

DATE TO BE COMPLETED BY: ____________________________

Workbook 24

Changing Your Behavior for Anxiety: Part One

CHANGING BEHAVIOR – Some behaviors, like avoidance or doing too much, will help you to feel less anxious in the short-term, but can actually intensify your anxiety in the long-term. This is because these behaviors keep you from facing the anxiety producing situation and learning to cope with it.

AVOIDANCE

1. PROCRASTINATIONWhen there is an activity that you anticipate will make you anxious, you may put it off or procrastinate.

2. AVOIDING PLACES, PEOPLE, OR ACTIVITIESYou may try not to put yourself in situations that could potentially provoke anxiety.

DOING TOO MUCH

1. REPETITIVE BEHAVIORS Sometimes anxiety is associated with repetitive behaviors that serve no clear purpose, like smoking, pacing, or excessive snacking.

2. CHECKING Anxiety can cause you to check on things to reassure yourself they are OK.

Changing Your Behavior for Anxiety: Part One

Record 1 or 2 situations you would like to face and/or repetitive behaviors you would would like to stop. For each, set a realistic goal that follows the SMART guideline. Then write the calming skills you will use to face these anxious situations.

Situation Avoidedor

Repetitive Behavior Goal Calming Skills to Help

Achieve Your Goal

ACTIVITY PLANNINGWe want to make sure to choose activities that are consistent with your life goals and values. Setting goals can help you to monitor change and progress over time. A guideline for setting goals is SMART.

Specific: What is the target for the goal? Who? What? Where?Measurable: How are you going to measure your success?Attainable: Is this a goal you feel confident that you can achieve?Relevant: How does this goal get you closer to a life goal, value or priority in your life?Timed: When is the goal to be completed? A week? A month?

Changing Your Behavior For AnxietyPart One Practice Exercises: Activity Schedule Log

Instructions for Practice ExercisesComplete the planned activities for the next week and record progress on the Activity Schedule Log. Remember, you may have to complete the activity several times before you notice a change in your mood. The more you practice, the easier it will be to face the anxiety producing situation or stop the repetitive behavior. You may experience a temporary increase in your anxiety, but this will decrease the more you practice.

Continue to practice using calming thoughts, deep breathing, and any other skills learned.

How likely are you to follow through with these steps in the next week?

1 2 3 4 5 6 7 8 9 10Not likely Very likely

Activity Completed: [ ] YES [ ] NO

Activity 1:________________________________________________________

________________________________________________________

Step 1: __________________________________________________Step 2: __________________________________________________Step 3: __________________________________________________

Calming skills I can use or help I may need from someone else:________________________________________________________

________________________________________________________

DATE TO BE COMPLETED BY: ____________________________

Date Completed: ______________________________

Changing Your Behavior: For AnxietyPart One Practice Exercises: Activity Schedule Log Continued

How likely are you to follow through with these steps in the next week?

1 2 3 4 5 6 7 8 9 10Not likely Very likely

Activity Completed: [ ] YES [ ] NO

Date Completed: ______________________________

Activity 2:________________________________________________________

________________________________________________________

Step 1: __________________________________________________Step 2: __________________________________________________Step 3: __________________________________________________

Calming skills I can use or help I may need from someone else:________________________________________________________

________________________________________________________

DATE TO BE COMPLETED BY: ____________________________

Changing Your Behavior For Anxiety: Part Two

Record 1 or 2 more situations you would like to face and/or repetitive behaviors you would like to stop. For each, set a realistic goal that follows the SMART guideline. Then write the calming skills you will use to face these anxious situations.

Situation Avoidedor

Repetitive Behavior Goal Calming Skills to Help

Achieve Your Goal

Instructions for Practice Exercises:

Complete the planned activities for the next week and record progress on the Activity Schedule Log. Remember, you may have to complete the activity several times before you notice a change in your mood. The more you practice, the easier it will be to face the anxiety producing situation or stop the repetitive behavior. You may experience a temporary increase in your anxiety, but this will decrease the more you practice.

Continue to practice using calming thoughts, deep breathing, and any other skills learned.

Changing Your Behavior For AnxietyPart Two Practice Exercises: Activity Schedule Log

How likely are you to follow through with these steps in the next week?

1 2 3 4 5 6 7 8 9 10Not likely Very likely

Activity Completed: [ ] YES [ ] NO

Date Completed: ______________________________

Activity 1:________________________________________________________

________________________________________________________

Step 1: __________________________________________________Step 2: __________________________________________________Step 3: __________________________________________________

Calming skills I can use or help I may need from someone else:________________________________________________________

________________________________________________________

DATE TO BE COMPLETED BY: ____________________________

Changing Your Behavior For AnxietyPart Two Practice Exercises: Activity Schedule Log Continued

How likely are you to follow through with these steps in the next week?

1 2 3 4 5 6 7 8 9 10Not likely Very likely

Activity Completed: [ ] YES [ ] NO

Date Completed: ______________________________

Activity 2:________________________________________________________

________________________________________________________

Step 1: __________________________________________________Step 2: __________________________________________________Step 3: __________________________________________________

Calming skills I can use or help I may need from someone else:________________________________________________________

________________________________________________________

DATE TO BE COMPLETED BY: ____________________________

Getting to Sleep

As people age, they tend to sleep less at night than when they were younger. Most older adults only sleep about 7 hours at night, and then take a nap around lunchtime if they feel tired. Often times, people may have trouble sleeping because they are worrying. If you do not get a good night’s sleep, remember that you can always get more the next night. Below are some simple rules that can help you to sleep better and feel rested the next day.

Nighttime Skills:

1. Go to sleep and wake up at the same time everyday.2. Develop a routine or habit when it is time to get ready for

bed. 3. Stretch legs or soak legs in a hot bath just before bed.4. Relax before bedtime or when waking up at night.5. Limit the use of the bed for sleep or intimacy with your

partner. 6. Get out of bed if you are not asleep in 15 to 20 minutes.7. Make your bed and bedroom as conducive to sleep as

possible

8. Decrease pain.

Daytime Skills:

1. Do not get into bed at all during the day.2. Try not to nap, or limit naps to 1 hour and no later than

3 pm.3. Do not drink caffeinated drinks in that afternoon or

evening.4. Exercise at least 3 or 4 days per week (at least 4 hours

before bedtime).5. Drink more fluids in the morning and less in the

evening.6. Try spending a few minutes each morning in natural

sunlight.

Getting to Sleep

Instructions for Practice ExercisesChoose a realistic time for going to bed each night and waking up each morning to help you get in the habit (mentally and physically) of getting a full 7 hours of sleep each night.

Goal bed time:_____________ Goal wake time:____________

Based on what you know about your current sleep hygiene and what was discussed during the session, choose 5 skills to practice to help you feel more rested each day.

Sleep Skills I am going to practice this week:

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

5. ________________________________________________________________________

Record Sleep Skills:Each morning or early afternoon, record what time you went to bed the night before and what time you woke up that morning. List the daytime sleep skills you used the day before and the nighttime sleep skills you used the night before. Note any problems you may have experienced while you were trying to sleep and what you did in response.

Continue to practice and use previously learned calming skills.

Date ___________ Time _______am/pm Day ___________

Getting to Sleep Practice ExercisesWhat time did you go to bed last night? What time did you wake up this morning?

Did you use any of the nighttime skills last night? If so, which ones?

Did you use any of the daytime skills yesterday? If so, which ones?

Did you wake up at any point last night? If yes, what may have caused you to wake up?

Did you do anything to fall back asleep? If so, what?

RELAXATION PRACTICEDid you use breathing skill today? [ ] YES [ ] NOIf so, did it make you more relaxed? [ ] YES [ ] NO

SELF-STATEMENTSDid you use a calming thought in a real life situation today? [ ] YES [ ] NOIf so, was it helpful? [ ] YES [ ] NO

Did you use other calming skills this week? [ ] YES [ ] NOIf so, were they helpful? [ ] YES [ ] NO

Problem Solving

Problem solving is part of daily life, but trying to solve problems when you are feeling anxious or stressed can be difficult. Anxiety can drain your motivation and energy to search for solutions to your problems and can even magnify the severity of the problem. Sometimes people have trouble generating solutions because they get stuck in a rut of thinking the same things over and over, or they may think that nothing can be done when really, it can. Other times, people have good ideas about how to solve problems, but never actually take the steps needed to make it happen.

THE “SOLVED” TECHNIQUE FOR PROBLEM SOLVING6 easy steps that will help you identify and solve problems in your life.

S = SELECT A PROBLEM First, select the problem to be solved. Be very specific and select problems that can realistically be solved.

O = OPEN YOUR MIND TO ALL POSSIBLE SOLUTIONS “Brainstorm” as many possible solutions as you can, without evaluating

them. Consider advice you would give to someone else or consider how you or others have handled similar situations in the past.

L = LIST THE PROS AND CONS OF EACH POTENTIAL SOLUTION Consider the consequences for each potential solution you have listed, then list the pros and cons of each.

V = VERIFY THE BEST SOLUTION Based on your pros and cons, put a check next to the best solution.

E = ENACT THE PLAN Identify what steps are needed to carry out the solution you have chosen. Make each step small so that you are easily able to achieve your goal. Next, carry out the plan.

D = DECIDE IF THE PLAN WORKED Now you can decide how well your solution worked. If your goal was achieved, congratulate yourself! If your plan was not effective, go back to

step “S” and select a new problem, or move to “L” to identify other potential solutions for the same problem.

Problem Solving

Instructions for Practices Exercises

Continue to practice and use previously learned calming skills.

Activate a Solution to a Problem:

1) “Enact the plan” for the problem discussed today.

2) During the week select 1-2 problems that need to be solved and use the SOLVED strategy to help find a solution.

Problem Solving: Practice Exercises

SELECT A SPECIFIC PROBLEM:

OPEN your MIND to ALL possible SOLUTIONS

List the PROS List the CONS

1.

2.

3.

4.

5.

ENACT THE PLAN (LIST THE STEPS BELOW)

1.

2.

3.

4. ___

TIME FRAME FOR COMPLETION:

VERIFY THE BEST SOLUTION: put a check by the solution you think will work best.

DECIDE IF YOUR SOLUTION WORKED: [ ] YES [ ] NO

Learn How to Relax IIPart One: Progressive Muscle Relaxation

PROGRESSIVE MUSCLE RELAXATION (PMR)The goal of progressive muscle relaxation (PMR) is to reduce the physical symptoms of anxiety that may include muscle tension, increased heart rate, and increased perspiration. This skill can be used along with deep breathing for further relaxation.

Sometimes tension builds gradually without our being aware of it happening. By learning to detect the initial signs of an increase in tension, you can use relaxation skills earlier, as opposed to waiting for anxiety to reach a very high level. Practicing the PMR procedure will help you learn to recognize and pinpoint tension in your body as soon as it occurs.

If you feel PAIN in any part of your body, avoid tensing muscles in that area.

To tense the SEVEN muscle groups:

1. Right arm: Make a fist and tense biceps, pull wrist upward while pushing elbows down against the chair or bed.

2. Left arm: Same as right arm.3. Face: Lift eyebrows as high as possible, clench jaws, and pull corners of mouth back

tightly.4. Neck and throat: Pull chin down toward chest, and at the same time, try to prevent it

from actually touching the chest.5. Torso: Take deep breath, hold it, and at the same time, pull the shoulder blades

together, trying to make them touch, and make stomach hard, as if someone were going to hit you.

6. Right leg: Lift foot off the floor and push down on the chair with thigh.7. Left leg: Same as left leg.

The goal is to relax all the muscles in your body – just let them become more and more relaxed. Focus on learning how to differentiate between when your muscles are tense and when they are relaxed. Practicing this skill will help you become more efficient at noticing tension during the day.

Learn How to Relax IIPart One: Progressive Muscle Relaxation Continued

Instructions for Practice ExercisesSet aside time each day when you can practice PMR for approximately 20 minutes in a non-distracting environment. Use the relaxation CD that we provided. It is helpful to use a high-backed chair to support your neck, but lying on a bed is okay, as long as you don’t fall asleep. Loosen tight clothing, remove shoes, belts, and glasses, and do not cross your arms or legs.

Throughout the tension-relaxation cycle, it’s important to concentrate on the sensations produced by the different exercises. Other thoughts may wander into your mind, particularly worrisome thoughts, but it is important to try to stay focused on the CD and on identifying the difference between tension and relaxation.

Two benefits occur from directing your attention to the physical sensations you’re experiencing: (1) you will learn a method to calm negative thoughts, and (2) you will develop a mental representation of the physical feeling of deep relaxation. This can be helfpul when you are in a stressful situation in which it is not possible to engage in the tensing procedure, but you are noticing and wanting to decrease muscle tension due to anxiety.

Record “yes” or “no” whether or not you used PMR and whether or not this skill helped you to relax.

Learn How To Relax II

Part One Practice Exercises

Date: Time: _______am/pm Day:

RELAXATION PRACTICE

Did you practice 7-muscle group PMR today? [ ]YES [ ]NO

If so, was it helpful? [ ]YES [ ]NO

Did you use relaxation in an anxiety situation today? [ ]YES [ ]NO If so, was it helpful? [ ]YES [ ]NO

CALMING SKILLS PRACTICE

Did you practice or use any other anxiety calming skills? [ ]YES [ ]NO

If yes, which ones? ____________________________________________________

Were they helpful? [ ]YES [ ]NO

Learn How to Relax II Part Two: Discrimination Training

Relaxation & Discrimination TrainingLast week you learned about progressive muscle relaxation with seven muscle groups. Now we are going to decrease the number of muscle groups so that ultimately this will be a portable skill that is useful in anxiety producing situations. Today we'll be practicing with four muscle groups, and we will change the procedure slightly to help you become more aware of the different levels of tension you may experience. This skill will help you notice tension before it reaches high levels.

This procedure is called discrimination training because it helps you to discriminate between different levels of tension. It is easier to release tension and become more relaxed when it is at a low level, so learning to recognize low levels of tension is another step toward dealing effectively with the physical signs of anxiety.

To tense the FOUR muscle groups:

1. Both arms: Make a fist with both hands and tense biceps – pull wrists upward while pushing elbows down against the chair or bed.

2. Face and neck: Lift eyebrows as high as possible, clench jaws, and pull corners of mouth back tightly and at the same time pull chin down toward chest – at the same time, try to prevent it from actually touching the chest.

3. Torso: Take deep breath, hold it, and at the same time, pull the shoulder blades

together, trying to make them touch, and make stomach hard, as if someone were going to hit you.

4. Both legs: Lift feet off the floor and push down on the chair with thighs.

RELAX. . .Now each time you exhale, repeat the word “relax” in your mind. Inhale, relax... Inhale, relax... Inhale, relax…

With practice, just thinking the word “relax” will become a cue for your body to release tension.

Learn How to Relax II Part Two: Discrimination Training Continued

Discrimination TrainingDiscrimination training is designed to help you recognize different levels of tension. It can be especially important to practice discrimination training in the face, neck, and torso because these are areas where tension is often first felt.

Follow the relaxation procedure that you have learned with the four muscle groups, but this time tense each muscle only half as much as usual, and then relax. Concentrate on the sensation of half-tensed muscles before you relax completely.

Repeat the relaxation skill and tense only half as much as the time before, or one-fourth the usual level. Concentrate on these sensations, and then relax completely.

Instructions for Practice ExercisesSet aside one practice time each day for approximately 20 minutes.

Relaxation: Record “yes” or “no” on whether or not you used the 4-group PMR and whether or not this skill was helpful for relaxation. Practice thinking the word “relax” as you exhale.

Discrimination Training: Record “yes” or “no” whether or not you practiced discrimination training and whether or not this skill was helpful for relaxation.

Try to use your new skill in a real life anxiety provoking situation!

Record whether or not you were able to use discrimination training in an anxiety provoking situation and whether or not it was helpful.

...and relax...

Learn How To Relax IIPart Two Practice Exercises

Date: Time: _______am/pm Day:

RELAXATION PRACTICE

Did you practice 4-muscle group PMR today? [ ]YES [ ]NOIf so, was it helpful? [ ]YES [ ]NO

Did you practice discrimination training today? [ ]YES [ ]NOIf so, was it helpful? [ ]YES [ ]NO

Did you use relaxation or discrimination in an anxietysituation today? [ ]YES [ ]NOIf so, was it helpful? [ ]YES [ ]NO

CALMING SKILLS PRACTICE

Did you practice or use any other anxiety calming skills? [ ]YES [ ]NO

If yes, which ones? ____________________________________________________

Were they helpful? [ ]YES [ ]NO

Changing Your Thoughts to Manage Anxiety IIPart One: Thought Stopping

Although everyone worries at some point, worrying is not productive and can interfere with your life. One strategy to reduce feelings of anxiety is to STOP the thoughts when they’re interfering with your life. Thought stopping helps you stop dwelling on anxiety-related images by using thoughts or images as cues to stop anxiety thoughts and allowing you to redirect your attention to relevant ongoing activities.

THOUGHT STOPPING1. Be aware of anxious thoughts.2. Disrupt the anxious thoughts by telling yourself (silently or out loud) “STOP!” and

picturing a big, red stop sign.3. Then, immediately direct your attention towards other things going on around you, such

as the people around you, traffic nearby, or objects in the room).

Instructions for Practice ExercisesPractice thought-stopping by imagining yourself in the anxiety situation. If you find that you can’t stop your anxious thoughts, tell yourself to “STOP” and picture a big red stop sign, or a big pink eraser, and then immediately redirect your attention to details of your surroundings or activities you may be in the middle of doing. Record “yes” or “no” whether or not you practiced this skill and if it was helpful.

Changing Your Thoughts to Manage Anxiety IIPart One Practice Exercises

Date: Time: ________am/pm Day:

What situation created stress/anxiety today?

___________________________________________________________________________

Where were you? Who were you with?

__________________________________________________________________________

What thoughts or worries did you have?___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

THOUGHT STOPPING: imagine yourself in the anxiety producing situation, then tell yourself to “STOP” and picture a big, red stop sign. Then immediately redirect your attention to other surrounding activities.

Did you use thought stopping? [ ]YES [ ]NO

If so, was it helpful? [ ]YES [ ]NO

Did you use any other calming skills this week? [ ]YES [ ]NO

If yes, which skills?___________________________________________________________

Were they helpful? [ ]YES [ ]NO

Changing Your Thoughts to Manage Anxiety IIPart Two

CHANGING THOUGHTSAnxiety can affect our thoughts, physical sensations, and behaviors. Although your thoughts, physical sensations, and behaviors are different, they affect each other in important ways. Often the way we think about things, or the way we interpret situations, influences the way we feel.

1. IDENTIFYING THOUGHTSThe first step is to identify thoughts associated with worry. This is part of increasing awareness, which you have been working on since our first session.

2. EVALUATE YOUR THOUGHTSThe next step is to evaluate how realistic these thoughts are. Begin to think of your thoughts as guesses or hypotheses, not facts. Then, take time to evaluate how realistic the thoughts are. Sometimes your thoughts will be realistic and sometimes they won’t. See if any of your thoughts are Examples of Negative Beliefs, described on page 46, and ask yourself the key questions that follow.

3. ALTERNATIVE THOUGHTSWhen thoughts are not realistic, the next step is to replace anxiety-producing thoughts with more realistic ones, with the idea that more realistic thinking will lead to less stress. We tend to assume that the first thought that comes into our head is the “truth,” so it’s important to open your mind to ALL other possibilities.

EXAMPLES OF NEGATIVE BELIEFS

FOR SURES: Overestimating the probability that something bad will happen, when it is unlikely, can create unnecessary anxiety. This type of thinking focuses on the extremes and allows no room for “middle ground.”

Key Words: definite, sure, absolutely, will, “either this or that” Key Questions: What is the actual chance that this will happen?

Am I only looking at the extremes of this situation?

Alternative Thought: Think realistically about the actual likelihood that the negative event will occur. Try to look for middle ground. Phrases to help make FOR SURES more realistic are “It’s more likely that...” and “The chance of ___ really happening is...”

SHOULDS: Having inflexible rules about how you or other people “should” behave or believing things “should” turn out a certain way can create expectations that are often not met. These rules are often unrealistic or do not apply to every situation. This type of thinking can lead you to assume responsibility for events that are out of your control.

Key Words: should, ought, must, if only I hadn’t, if only I hadKey Questions: How much control do I really have in this situation? Can anything I say or do really change what someone else believes or how

he/she acts?Is this expectation reasonable for this situation?

Alternative Thought: Ask yourself if your rule or expectation is realistic. Phrases to help make SHOULDS more realistic are “It would be nice if…” and “Unfortunately… but thankfully…”

BIG DEALS: Sometimes people worry about things that, even if they did occur, would not be a big deal. If you are “making mountains out of molehills,” you may be creating unnecessary anxiety for yourself.

Key Words: terrible, awful, horribleKey Question: What’s the worst thing that could happen?

Alternative Thought: Ask yourself “what if” your fear came true. Is it really a big

d

eal? Could you cope with it?

Changing Your Thoughts to Manage Anxiety IIPart Two Continued

Instructions for Practice ExercisesContinue to practice previously learned calming skills.

Changing Your ThoughtsChange your anxious thoughts by first identifying them, and then evaluating how realistic they are. Watch out for Negative Beliefs: FOR SURES, SHOULDS, and BIG DEALS. Think carefully about the questions on the Practice Exercise form and check “yes” or “no” to indicate whether or not a logical error applies to your thoughts. Then, identify an alternative thought and record it on your form.

Remember: This is not an easy skill to learn, especially if you have thought a certain way for a long time. FOR SURES, SHOULDS, and BIG DEALS are habits that may have formed over a long time, so it takes time to break these habits. Just like the other skills you’ve learned, changing your thoughts to manage anxiety requires lots of practice!

Date: Time: _______am/pm Day:

Changing Your Thoughts to Manage Anxiety IIPart Two Practice Exercises

What situation created stress/anxiety today?

___________________________________________________________________________

What thoughts or worries did you have?___________________________________________________________________________

___________________________________________________________________________

EVALUATE YOUR THOUGHTSTake a moment to think about each question individually before you answer it.Am I only looking at the extremes of the situation? [ ]YES [ ]NOAm I assuming that something negative is going to happen? [ ]YES [ ]NOIs this a situation I really have control over? [ ]YES [ ]NOIf this happened, would it really be the worst thing in the world? [ ]YES [ ]NOCould I be over estimating the risk of something bad happening? [ ]YES [ ]NODoes my thought include the word “should”? [ ]YES [ ]NO

For situations that involves other people:Am I assuming that I know what someone else is thinking? [ ]YES [ ]NO Does my thought describe a rule that someone else “should” follow? [ ]YES [ ]NO

ALTERNATIVE THOUGHTProvide a more realistic thought or thoughts.___________________________________________________________________________

___________________________________________________________________________

Did you use other calming skills this week? [ ]YES [ ]NOIf yes, which skills?

Were they helpful? [ ]YES [ ]NO

Maintaining a Peaceful Life

In this session, you reviewed all the new skills you have learned to cope with anxiety. Now you have a “tool box” of calming skills from which to choose when you find yourself in an anxiety producing situation. Some calming skills may become your “favorites” and will be used more frequently than others. You may find that some skills work best in certain situations, while others work best in different situations.

Now it is your job to continue practicing the skills and incorporating these tools into your daily life.

SUMMARY OF CALMING SKILLS1. Relaxation: Deep breathing is a relaxation skill that entails taking long, slow, deep breaths from your diagphragm.

2. Calming Thoughts – Calming thoughts are instrucations you give yourself to help manage your anxiety.

Other skills you have learned:

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Maintaining a Peaceful Life

PEACEFUL LIVING MAINTENANCE PLANYou have now completed the first part of the Peaceful Living program, and you have learned many new skills to decrease your anxiety. At this point, it is very important that you continue to practice your skills in order to integrate your new tools into your daily life. One way to maintain the progress you have made is to plan ahead for situations that you know have been anxiety producing for you in the past.

What are situations that might make you anxious in the future?

Situations Calming Skills

How will you know if you’re getting anxious?

Thoughts, physical symptoms, behaviors Calming Skills

Maintaining a Peaceful Life

CONTINUE TO PRACTICEWith continued practice, most people continue to get better at managing their anxiety, even after they have finished this part of the program. You may find that your anxiety and your ability to manage it improve over the next year. You may want to set aside a specific time each day to review what you learned during the program. Or you may find it helpful to keep notecards with them that provide cues or reminders to use certain skills. The important thing is to come up with a plan that works for YOU and will help you to maintain the gains you have made during the program.