Understanding and Managing Anxiety

Workbook

Designed and produced by the Involvement, Recovery and Wellness Centre.

Please contact 01625 505647 for further information.

1
References:
All pictures used have been sourced from free website www.pixabay.com
Page 4 - 5: 1Anxiety Self-help Guide – NHS Inform: https://www.nhsinform.scot/illnesses-and-
conditions/mental-health/mental-health-self-help-guides/anxiety-self-help-guide
Page 8: 2 Fight or Flight Response Symptoms, CBT4Panic: http://cbt4panic.org/the-fight-or-flight-
response-symptoms/

Page 11: 3 Colour Breathing: www.get.gg © Carol Vivyan 2010. Permission to use for therapy
purposes. www.getselfhelp.co.uk
4
Page 12: 7/11 breathing: https://www.in8.uk.com/information-resources/7-11-breathing/

Page 13 - 14: 5 Diaphragmatic Breathing Technique with images: https://www.yumpu.com/en/

document/read/26573625/diaphragmatic-breathing

Page 15: 6 Mental Health Continuum Model: www.mentalhealthcommission.ca/

Page 15: 7 Stress Symptom's: https://www.mind.org.uk/information-support/types-of-mental-

health-problems/stress/signs-of-stress/

Page 18: 8 Quote from Lisa M. Hayes: www.rawfoodforlife.org

Page 19 - 20: 9 Stress Bucket: https://mentalhealth-uk.org/blog/the-stress-bucket/ Developed

from an idea by Brabban and Turkington (2002) Exercise: https://www.foryoubyyou.org.uk/

Page 21: 10 https://www.sonia-jaeger.com/en/stress-and-the-glass-of-water/

Page 23: 11 http://counsellingservice.eu/wp-content/uploads/2012/09/Assertiveness_Table.png

Page 24 - 27: 12 Problem Solving Technique extracted from Self-management of Long-term

Health Conditions. A handbook for people with chronic disease. Kate Lorig, DrPH 2012
13
Page 28 - 29: CIRCLE of CONCERN and CIRCLE of INFLUENCE: Adapted from The Seven
Habits of Highly Effective People by Stephen R. Covey, Simon & Schuster 1992.

Page 30 - 31: 1Anxiety Self-help Guide – NHS Inform; https://www.nhsinform.scot/illnesses-and-

conditions/mental-health/mental-health-self-help-guides/anxiety-self-help-guide

Page 34: 14 Mindfulness in 5 4 3 2 1 utilised by many therapists worldwide

Pages 35 - 36: 15 Action Planning Technique extracted from Self-management of Long-term

Health Conditions. A handbook for people with chronic disease. Kate Lorig, DrPH 2012

Page 37: 16 Visualisation Script Exercise: Anxiety Self-help Guide – NHS Inform: https://
www.nhsinform.scot/illnesses-and-conditions/mental-health/mental-health-self-help-guides/
anxiety-self-help-guide

Page 40: Self-Management Checklist: devised by staff and users of CWP Specialist Mental
Health Services via IR&WC 2018

Booklet assembled by staff of IRWC CWP NHS FT 2019, pending consultation with people who
use our services and their carers
2
 WELCOME
This booklet has been designed to be used as a standalone tool
with any other support you might be receiving and alongside the
Understanding and Managing Anxiety workshop. It is designed
to help you self-manage symptoms of anxiety. Part of self
management is knowing when you need further support. If you
find your symptoms continue to stay the same or worsen, please
be sure to seek further support from your care team or GP.
PERSONAL INFORMATION

Name:

Address:

Postcode:

Contact number:

Diagnosis:

Other medical conditions:

3
 WHAT IS ANXIETY?
Anxiety is a general term used for several disorders that cause
nervousness, fear, apprehension and worrying. It can vary from
day to day and throughout the day.
One of the ways you can spot when you are anxious is by
looking at the physical symptoms of anxiety.

Take a look at some of the physical symptoms of anxiety

below and circle which you feel apply to you when you are
anxious.
Excessive thirst
Drowsiness
Sweating Shortness of breath
Frequent urinating

Pins and needles

Muscle aches

Nausea
Tiredness

Stomach ache
Dry mouth
Painful or missed
Diarrhoea
Heart palpitations periods

Head Aches Difficulty falling or staying asleep

These unpleasant symptoms can cause people to worry that

what is happening is harmful. These fears can consequently,
make people even more anxious, which can create a vicious
cycle. 1
4
 What other things might you notice if you are
experiencing anxiety?
Circle those that you have noticed yourself and add your own 1

Feelings you might have:

On edge Scared
Nervous Overwhelmed
Panic Irritable/Lack of Patience
Stressed Uptight

How your body might feel:

Breathing faster/Feeling breathless Sweating
Stomach churning Tense/sore muscles
Chest tight/painful Dizzy/faint
Heart racing/palpitations Difficulty concentrating

Things you might do:

Avoid things that make you anxious or things you normally enjoy
Find it hard to relax
Snap at people easily
Talk very quickly

Thoughts you might have:

I’m going to die
I can’t cope
Others are not safe / they’re going to die
Something bad is going to happen
I’m not safe

5
 WHAT CAUSES ANXIETY?
A mixture of the following factors can contribute to someone being
more likely to have trouble with anxiety. Write in the boxes below
examples of which factors you think could be contributing to
you feeling anxiety.

6
 IS ANXIETY NECESSARY IN OUR LIVES?
Sometimes feeling anxious can be beneficial, for example to pre-
pare for an interview or a race. However, anxiety is considered a
problem if it starts to interfere with things like sleeping, eating,
socialising and otherwise functioning.
What aspects of your life do your symptoms of anxiety in-
terfere with? Try to be honest and remember that knowing
how anxiety affects you is the first step to working on it and
feeling better.
My anxiety affects me by…
“It stops me from going to visit my family!”

Anxiety is a general term for several disorders that cause nervousness,

fear, apprehension, and worrying.

Anxiety experienced by
everybody.

Many of the physical symptoms link into the fight or flight response as
adrenaline pumps around the body, preparing you for battle or to
escape the situation causing anxiety.
Have a look at next few pages to help you understand what happens
when our body goes into the fight, flight, freeze response.
7
2

Your brain does not recognise any difference between a real danger i.e.
fear, e.g. a snarling dog and a perceived danger e.g. being worried
about answering the telephone (anxiety). Therefore, you will have the
same response to both fear and anxiety.

8
THE FIGHT OR FLIGHT RESPONSE

The “fight or flight” response happens in our

bodies and brains when we feel there is a
danger.

The “fight or flight” response is different in

different people.

There are many things that can happen when

someone has a “fight or flight” response.

 You might start breathing faster or not

breathing as deeply

 You might get a dry mouth

 You might get sweaty

 You might suddenly need the toilet

 You might find it hard to concentrate

 You might feel sick

There are also other things not on the list that

can happen.

9
You can get the “fight or flight” response
whether the danger is real or not.

You could get the “fight or flight” response when

the danger is real, like an angry dog growling at
you. This is called fear.

You could also get the “fight or flight” response

when the danger is not real, such as being in a
crowded place. This is called anxiety.

Everyone can experience both anxiety and fear.

When the “fight or flight” response happens, you

can use breathing techniques to calm down.

Breathing techniques slow your breath down.

Breathing techniques send a signal to your

brain that the danger/anxiety has passed.

Breathing techniques take time and practice to

be effective.

10
 BREATHING TECHNIQUES
Below are some breathing techniques you could try. Not every
technique works for everyone. Try a technique a few times and
see if it works for you.
Colour breathing 3

Colour breathing involves mentally picturing or meditating on a

colour that represents how you want to feel and/or what you
want to let go of in your life.

For example, you could breathe in the colour blue for peace and
breathe out the colour grey to breathe out low mood. Or you
could picture yourself breathing in gold and the energy filling
your body as you breathe in.

Some more examples of colours for colour breathing:

Blue is the colour of relaxation and peace.

Turquoise is the colour of calm and cleansing.
Green is colour of healing.
Magenta is the colour of release.
Orange is the colour of fun, happiness and joy.
11
 7/11 breathing 4

Breathe in and count from 1 to 7 on each “in” breath (this does

not have to be 7 seconds, it can be for 7 counts)
Breathe out then count at the same rate, from 1 to 11 on each
“out” breath.
If breathing in for 7 and breathing out for 11 is too long, you can
try breathing in for 3 and breathing out for 4.

12
Diaphragmatic breathing technique 5

13
 THE MENTAL HEALTH CONTINUUM 6

Anxiety can show itself in different ways in people, and can range from
mild to severe. The mental health continuum model is a visual way of
showing this.
Where are you on the mental health continuum when you are
feeling well? Where are you when you are not feeling so well?

www.mentalhealthcommission.ca/

14
 STRESS OR ANXIETY? 7
Stress is a response to an external cause, such as a tight deadline at
work or having an argument with a friend, and subsides once the situa-
tion has been resolved.
Anxiety is a person’s specific reaction to stress; its’ origin is internal.
Anxiety is typically characterised by a “persistent feeling of apprehension
or dread” in situations that are not actually threatening. Anxiety persists
even after a concern has passed.
Stress and anxiety can affect us physically, emotionally and
behaviourally.

PHYSICALLY EMOTIONALLY BEHAVIOURALLY

FATIGUE DIFFICULTY EATING MORE/

CONCENTRATING LESS

DRY MOUTH ANXIETY SMOKING MORE

POUNDING PANIC ATTACKS AVOIDING THINGS
HEART

SWEATING TEARFUL NAIL BITING

NAUSEA LOW SELF- SLEEPING MORE/
CONFIDENCE LESS

STIFF MUSCLES ANGER DRINKING MORE

SHAKING FEARFULNESS NOT CARING FOR
YOURSELF

ERRATIC CONFUSION BEING OVERLY

BREATHING TALKATIVE

DIZZINESS DEPRESSION BEING QUIET/SHY

RESTLESSNESS IRRITABILITY SWEARING MORE
15
 SELF TALK
Self talk is the way you talk to yourself, or your
inner voice. You might not be aware that you're
doing it, but you most likely are. Self talk is
important because it has a big impact on how
you feel and what you do.

Examples of negative self talk can be seen below.

“I know I look awful today.”
“I’m sure he hates me”
“I’m so stupid!”
Can you think of your own examples? Write them in the box below
“I’m useless!”

How could you change the above to something more positive?

“I’m not able to do this at the moment, but in the future…”

16
 POSITIVE AFFIRMATIONS
Affirmations are thoughts or words we can say, to trick our brains into
being more positive or to make us feel better.

Feel the fear and

do it anyway!

17
 THE STRESS BUCKET 9
Imagine there’s a bucket you carry with you which slowly fills up when
you experience different types of stress. Sometimes you feel strong
enough to carry a lot of stress, but it’s important to find activities which
help you lighten the load.
What helps you reduce stress?

How can you keep those activities going when other pressures build up?

18
9
Complete your own stress bucket and see where your stresses

19
A psychologist raised a glass of water and asked the
class -
“How heavy is this glass of water?
The group replied with guesses of 150grammes,
300grammes.
She replied,
“ The actual weight doesn’t matter, but the longer I
hold it the heavier the glass feels.”
The stresses and worries in life are very like that
glass of water. If I think about them for a little while,
nothing happens. If I think about them for a bit longer
they begin to hurt. And if I think about them all day
long, I will feel paralysed and incapable of doing any-
thing!”
Try to remember to put the glass down!” 10

20
 COMMUNICATION SKILLS
 Be assertive
 Be straight-forward
 Learn how to say “No” without feeling guilty about it!
 Use ‘I’ messages rather than ‘you’ messages
 Allow enough time for yourself to get your message across
 Write down some notes about what you’d like to communicate
 Bring someone with you to support you if necessary
 Use good eye contact
 Be aware of your body language
 Use short and simple sentences
 Speak clearly and loud enough to be heard
 Sit face to face
 Try to ensure you have no distractions

21
 11
e
t iv
e r
s
As
Aggressive Passive

The Aggressive Per- The Assertive Person The Passive Person

son
Interrupts and ‘talks Speaks openly Is afraid to speak up
over’ others
Speaks loudly Uses a conversational Speaks softly
tone
Glares and stares at Makes good eye con- Avoids looking at peo-
others tact ple
Intimidates by using Shows expression Shows little or no
expression which matches the expression
message
Stands rigidly, crosses Relaxes and adopts an Slouches and with-
arms, invades the open stance and draws
personal space of oth- expressions
ers
Controls groups Participates in groups Isolates self from
groups
Only considers own Keeps to the point Agrees with others de-
feelings and/or makes spite personal feelings
demands of others
Values self more than Values self equal to Values self less than
others others others
Hurts others to avoid Tries not to hurt any- Hurts self to avoid hurt-
being hurt one (including self) ing others
Reaches goals but Usually reaches goals Does not reach goals
hurts others in the pro- without hurting others and may not even know
cess goals
I’m okay, you’re not I’m okay, you’re okay You’re okay, I’m not
22
 ASKING OTHERS FOR SUPPORT
Sometimes certain ways of thinking can get in the way of being
assertive. Some of these ways of thinking can be seen below.
See if you can think of more helpful ways of thinking for each
example below.
 “Asking for help is a sign of weakness.”
It takes courage to ask for help, because I know how hard it is for me.
Helping others helps me to feel useful. Maybe others might feel useful
helping me?
 “People don’t have time, I’m just a burden.”

 “I'm not worthy of help or support.”

 “Asking for help means I’m incompetent.”

 “I’m the only one who can do this properly – it’ll just be quicker
and easier for me to do.”

 “I’ll have to reciprocate if I ask for

help.”

We’ll be looking at Unhelpful Thoughts

in more detail later.
23
 Joan often finds that
she has a number of
tablets left at the end of
the month when she
should have taken
them.

Problem-Solving
12
Exercise She normally has to
take 6 tablets in the
morning and 4 in the
evening.

Think of any possible

solutions or ideas to
ensure Joan takes her
medication correctly.

24
Part 1. Solutions to help Joan remember to take her medications properly…..

Part 2. List all the solutions you can think of

1.
2.
3.
4.
5.
6.
7.
8.
9.
Part 3. Agree on the best solution and try it out. Circle which solution you
would like to try out.
Part 4. Review the results – if that idea doesn’t work don’t give up! Go back
to the list and choose another idea.
Part 5. Utilise other resources such as friends/family or professionals.
Part 6. When all solutions have been tried it may be that the problem is not
solvable at this point in time. At this stage, you can try another self manage-
ment strategy.
25
Joan often finds that she has a number of tablets left
at the end of the month when she should have none.
She normally has to take 6 tablets in the morning and
4 tablets in the evening before bed.
What can she do to help her remember to take her
medications?

Possible Solutions:

Joan could get in contact with her pharmacy and ask if

they can provide a pre-packed blister pack.

 She could ask her care giver or a family member to ring and
remind her each morning and evening.
 Joan could set an alarm reminder on her mobile
 She could put her medications beside or near her tooth-
brush as brushes her teeth at the same time her tablets
need taking.
 You can also use a dry-erase board to keep track of pills you
have taken, erasing reminders after each Turn your
bottle upside down after you take meds
 Leave yourself notes to help you remember. Post-it notes on
your bathroom mirror or nightstand work great.
 Keep a diary and write down each time you
take your tablets.

Try out the chosen solution, if

it works - great; if not, follow
steps 4, 5 and 6.
26
 Try this yourself… PROBLEM SOLVING
Sometimes worrying about a problem can make anxiety worse. Problem solving
can be an effective technique to find a solution or to realise that at this time there is
no solution and another self management strategy is required.
The steps to problem solve can be seen below. Try using a problem you have
and writing out a problem solve below.
1. Pinpoint a problem or goal. Write down what your problem or goal is. Try to
be as specific as possible.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

2. List all the possible solutions and ideas. List your ideas below. Don’t worry if
they sound silly—the trick here is to just list as many ideas that you can think
of.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

3. Agree on the best solution and try it out. Circle which solution you would like
to try out.
4. Review the results – if that idea doesn’t work don’t give up! Go back to the list
and choose another idea.
5. Utilise other resources such as friends/family or professionals.
6. When all solutions have been tried it may be that the problem is not solvable at
this point in time. At this stage, you can try another self management strategy.

27
 CIRCLE OF CONCERN AND CIRCLE OF
CONTROL 13
Some issues are within our control. However, there are some things we cannot
control. The trick is being aware of what is within our control and what is not.
•Be honest with yourself
•Don’t waste energy on things you can do nothing or very little about!
Have a look at the examples below and fill in your own circles on the next
page.

28
 13

29
Common Unhelpful Thinking Patterns: 1
1. Catastrophising: People often catastrophise when they’re anxious,
making them feel things are far worse than the actuality, e.g. “My
partner is late, they must have been in an accident.”
2. Black and White Thinking: We often see things in black and white
when anxious—leaving no ‘in between.’ e.g. Gary hasn’t been to
see me for ages, he must hate me.’
3. Emotional Reasoning: This is treating your emotions as if they are
facts: I’m terrified of going to the new group—something bad is go-
ing to happen.’
4. Must and Should Statements: People can live by fixed rules they
have put in place for themselves about what the ‘should’ or ‘must
do, e.g. “I should be able to manage.”
5. Jumping to Conclusions: We often assume we know what other
people might be thinking and these suppositions lead to ‘what if’
scenarios about the future, e.g. “I can’t drive anymore, I’m not going
to be able to do anything anymore.”

How can we Challenge these Unhelpful

Thoughts:
1. Take note of the situation
2. Denote your feelings about the situation
3. Write down your unhelpful thought
4. Breakdown evidence for and against the unhelpful thought
5. Use the evidence checking questions on the following page to help
you.

30
 Helpful questions to ask yourself to
determine if your unhelpful thought is
fact or opinion: 1
Let’s use one of our previous unhelpful thoughts as an example:
“My partner is late, they must have been in an accident.”
1. Is there any evidence against this thought? E.g. They’ve never
had an accident before; They’re a safe driver, Nobodies phoned to
say there’s been an accident.
2. Is there any evidence for this thought that is based in fact? E.g.
‘they’re usually only half an hour getting home’, ‘they’re not usually
late’, ‘they call me if they’re delayed’.
3. Can you identify any unhelpful thinking patterns? E.g. thinking
that they’ve had an accident is catastrophising.
4. What would I say to a friend in a similar situation? E.g. ‘They’ve
probable got stuck in a traffic jam and can’t ring you.’
5. Is there another way of looking at this situation? E.g. ‘They
might have just forgotten to ring me to say they’d be delayed’.
6. Is there a more proactive solution to this unhelpful thought?
This would be the more balanced thought. E.g. Maybe I could do
a crossword to distract myself and if they haven’t arrive in 15 more
minutes I’ll try phoning them.’

31
 Take your thoughts to court to gain a
balanced viewpoint

Thought Record

Event/ Anxious Feelings and

Circumstances/ Thoughts Sensations
Trigger

See friend, wave She’s fallen out Sick, sad and

at them but get no with me / doesn’t worried
response like me anymore

Breaking it down

Evidence Supporting My Evidence Against My

Anxious Thoughts Anxious Thoughts

She didn’t wave back so must Maybe she didn’t see me as it

be ignoring me was quite busy

She’s not contacted me for ages She’s got a lot on her mind,
maybe she was busy thinking
and didn’t notice me
Nobody likes me My family and friends like me

I must have done something to I haven’t done anything to my

cause this knowledge that would annoy
her

32
 Now it’s your turn
Thought Record

Event/ Anxious Feelings and

Circumstances/ Thoughts Sensations
Trigger

Breaking it down

Evidence Supporting My Evidence Against My

Anxious Thoughts Anxious Thoughts

33
 14

Can be used when you feel ….

anxious, angry,
uneasy, sad, content,
happy, joyful, grateful…
Anytime!
Think of...

Things you can see

Things you can hear

Things you can feel

Things you can smell

DEEP BREATH

34
Action Planning 15
To help you meet
your goals

What? A specific task

How much? Measurable

When? Day/Time

How many times? How

often that week?
Score 0-10 ? We look for a
7 or more.

A journey of a thousand miles begins with a

single step Lao Tzu

35
 Example Action Plan 15
What? A specific task Go for a short walk

How much? Measurable 15 mins

When? Day/Time Wednesday and Friday at

noon

How many times? How Twice

often that week?
Score 0-10 ? We look for a 7 If you’re score is under 7
7 or more. you might need to change
it!

Now you try…...

What? A specific task

How much? Measurable

When? Day/Time

How many times? How

often that week?
Score 0-10 ? We look for a
7 or more.

36
 Relaxation/Visualisation Script: Exercise 16

 I invite you to take a deep breath and when you're comfortable, begin to
close your eyes [pause].
 I wonder if you would take a moment to imagine yourself being more calm,
peaceful and focused [pause].
 And as you allow your unconscious mind to naturally conjure an image of
what that would feel like; consider what you might be seeing [longer
pause], hearing [longer pause] and what you might be feeling [longer
pause] that shows you are more calm, peaceful and focused [pause].
 And perhaps you are already feeling more calm, peaceful and focused
[pause].
 If not, notice that your unconscious mind can reveal how you might do this
[longer pause].
 Now, maybe you can think of a simple way to incorporate this feeling of
calm into your life in the days and weeks ahead [longer pause].
 And after you have done that, know that it really can be this easy to create
a little more peace and calm in your life [pause].
 So, I invite you now to take a breath for a moment, and begin to move your
attention back to the room, listening to the sounds around you and begin to
open your eyes [pause].

So, how was that? What did you learn?

37
Can you think of other ways to help with your anxiety?
Activities

Ways to help you feel calmer

38
 Can you think of other ways to help with your anxiety?
Activities—examples
Read a book or magazine
Spend a bit of time with a good friend or family member
Watch your favourite television show
Listen to the radio
Play golf or go for a swim at the local baths
Do something creative—paint, draw, knit,
Do some exercise—go for a short walk, go to the local shops
Do some gardening if the weather permits
Keep with my routine: Use action planning
Play a card game e.g. solitaire

Ways to help you feel calmer– examples

Self-soothe with a relaxing bubble bath
Practice self-compassion—Write yourself a compassionate letter
Do a controlled breathing exercise
Use a mindfulness exercise such as the 5 4 3 2 1 method
Do a visualisation / relaxation exercise
Listen to your favourite relaxing music
Stroke your pet if you have a cat, dog or other
Get a nice hug from a loved one
Light a scented candle e.g. Lavendar
Have a nice treat e.g. slice of cake with your cuppa
39
 
Self Management Checklist
a) Talk to someone—a good person for me to
ring is ………………………………………….

b) Breathing techniques—I like to use

………………………………………………..
c) WRAP book—do I have any action plans that
will help me?
d) Mindfulness—staying in the moment. One
mindful activity I enjoy doing is
……………………………………………….
e) Self Soothe—something I like to do to
comfort myself (eg relaxing bath, music)
Something I do to self soothe is
……………………………………………….
f) Get my muscles moving to release
endorphins. A type of exercise I enjoy is
……………………………………………….
g) Distraction—focusing attention else where
can help, like doing a puzzle. I like to
…………………………………………….
h) Relaxation CD or meditation—like a
visualisation or body scan. I like to do
……………………………………………
i) Medication—is it being taken properly or can I
take PRN medication
40
Notes:

41
Notes:

42
 Please remember that we are all different
and have had different life experiences, but
there are ways in which we can help
ourselves.
However, it is important to remember to go
slowly and take pleasure in the journey, and
to realise that change takes time and
practise.

Patience is not the ability

to wait, but the ability to
keep a good attitude
while waiting.

43