I Need Help With Anxiety
Norfolk and Suffolk NHS Foundation Trust
CFYP Advice and Signposting
Helping you find your way with mental health
I Need Help With: ANXIETY
Anxiety is a feeling that everybody experiences. It has always been an important warning system for humans. For example, cavemen could rely on their anxiety to help them survive being faced with a sabre-toothed tiger. The human anxiety system triggered their bodies to go into survival mode, making their bodies release a hormone called adrenaline. This made their bodies get ready for either fighting the tiger, or running away from it; known as the 'fight-flight' response. These days, people don't need to worry about sabre-toothed tigers, but the warning system is still there for when we need it. That's why your body does all sorts of weird and wonderful things when you are feeling anxious; from your heart racing, to your muscles tensing up.
Often, though, humans worry about things that are not dangerous, such as harmless spiders, or whether or not someone likes us. It's a bit like our warning system is extra sensitive even when it doesn't need to be - like a car alarm that goes off when a leaf falls on it.
Even though the thoughts, feelings and physical changes that come with anxiety can do no harm, most people don't like them. So, they try to do whatever they can to feel less anxious; usually through avoiding the things that trigger the anxiety (e.g. avoiding spiders). Avoidance often helps to relieve the anxiety in the short-term, but in the long-term it often makes the anxiety stronger. That's because when you avoid the anxiety, you can never find out whether your anxious thoughts are accurate or not. So, if you always avoid going in the dark attic because you're afraid there might be ghosts up there, you'll never know if there actually are any ghosts to be scared of.
NOTICING Anxious Thoughts and Feelings...
It can sometimes feel like anxious thoughts stick in your head like superglue. No matter how many times you try to push them out of your mind - they keep coming back. Try to think of anything except a pink elephant for the next minute... Impossible isn't it! The more you push the thoughts away, the more powerful they become.
To improve anxiety, you will first need to explore it. This might feel scary at first, but you need to know what you're avoiding and why before you can work out how to overcome it.
The Anxiety Trap
Start by using the 'Worry Diary' worksheet to log your thoughts, feelings and safety behaviours (what you do to feel more safe when you feel anxious) over the next week. The 'FEAR' acronym may help you think about which types of responses (behaviours) you choose:
Find 'help'... get someone to rescue you..
Escape the situation... by foot or by distraction
Avoid... going to the situation or things associated with it
Reassurance... check everything's OK by asking or repeating
You can use the 'Feelings' worksheet to help pick the emotions that best describe how you feel. You can also complete the 'How Does Anxiety Affect the Body' worksheet to help you notice the physical symptoms that anxiety brings for you. Then, at the end of the week, use the information you have logged to help you complete the ‘Anxiety Trap’ worksheet. This should help you see how your thoughts, feelings and behaviours are linked, and how avoidance is maintaining the anxiety.
Worry Diary Worksheet
Keep track of your thoughts, feelings and behaviours over the next week.
At the end of the week, look for any themes to your thoughts, or patterns to your behaviours.
Day e.g. Wednesday …
Time e.g. 6pm …
Rate your anxiety from 0-100% = very anxious e.g. 80% …
What was happening just before you felt anxious e.g. watching TV and saw a spider on the floor …
What were you thinking when you were feeling anxious e.g. “it’s going to crawl up my leg” …
What did you do to make yourself feel less anxious? i.e. your safety behaviours e.g. left the room …
Search the feelings wheel for the words that best describe how you feel. Use this to help you complete your Worry Diary.
[note: accessible version of the feelings wheel not available]
How does anxiety affect the body?
Everyone experiences anxiety in their bodies in slightly different ways.
Label or draw on a person below how anxiety affects YOUR body
Anxiety Trap Worksheet
Fill in the boxes using the information gathered in your Worry Diary
Thoughts e.g. “nobody likes me” …..
… to …. Feelings … e.g. “scared” ….
to … Safety Behaviours e.g. “avoid texting classmate”
… short term relief …
… to … Thoughts ….
Based on Greenberger & Padesky (1995)
CHOOSING Different Responses to Anxiety
We can't choose our thoughts, and it's very hard to control our feelings (imagine trying to stop feelings of excitement or fear at the top of a rollercoaster).
The one bit of your anxiety trap that you CAN change is what you do in response to anxiety.
You can choose to avoid or run away from anxiety, which in the long term will keep you stuck in the anxiety trap. Or, you can choose to gradually Face your anxiety, so that you can find out if there's anything that you really need to worry about.
Where to Start
Anxiety can feel like an enormous mountain to climb. But with the right knowledge (which you now have), and the right skills (which you're about to learn), you can gradually make your way to the top. Start by writing down all of the situations that you are scared of on pieces of paper or post-it notes (so, all the situations that make you want to use your safety behaviours). Then, arrange them in a line; put the one that would feel most scary to face at the top, and the one that would feel least scary to face at the bottom. Now arrange all the others in-between. When you're done you can use the 'Anxiety Ladder worksheet' to write them down, and rate how anxious you would feel if you had face the situation without a safety behaviour.
Test it Out
Now all that's left to do is to start choosing a different response to your anxiety, and see what happens. Start with the one at the bottom of your ladder. It should feel like a challenge that's a bit out of your comfort zone, but it should not feel too scary to try. Imagine you're a scientist, testing out how believable your anxious thoughts really are. You can write down your findings on the 'Test it Out' worksheet.
Anxiety Ladder Worksheet
Order the situations that make your feel anxious; put the one that feels most scary at the top of the ladder, and the one that feels least scary at the bottom. Order the other situations in-between.
Rate how anxious you feel about each one; 0 = not too scared at all , 700 = the most scared
TIP: Break down the BIG things into smaller chunks. Mount Everest is too high to climb in a day, but if you take it slowly and break it into chunks, it’s more manageable.
Test it Out worksheet
Start with the situation that is at the bottom of your Anxiety Ladder. Fill in the 'Preparing' grid below and then challenge yourself to NOT use your safety behaviour.
Although your anxiety may increase initially, it cannot hurt you and it will gradually reduce over time. Afterwards, write down your observations in the 'Learning from doing something different' grid; what happened and did your anxiety change?
The thought to be tested: …
How much I believe the thought (rate 0-100%) …
How can I test the thought (Hint: it's likely to involve avoiding less and dropping your safety behaviour) …
What might get in the way of me testing out the thought? …
What can I do to overcome these barriers and test the thought out anyway? …
Learning From doing something different:
What happened when I dropped my safety behaviour: …
How much I believe the thought now (rate 0-100%): …
What's my next challenge (pick the next one up on your Anxiety Ladder): …
Filling the Gaps worksheet
As you gradually reduce gour safety behaviours and start avoiding things less, gou might find gou have more time on gour hands. Take this opportunity to start (or re-start!) doing the things gou enjoy. Write down a few activities and plan how you'll put them into action.
What I want to do more of: e.g. Meet up with my friends …
What I need to do to get started: e.g. Text Josie to say ‘hi’ …
When can I make a start: e.g. Tonight …
What I want to do more of: …
What I need to do to get started: …
When can I make a start: …
What I want to do more of: …
What I need to do to get started …
When can I make a start: …
Keeping on Top of Anxiety
Anxiety will always be around. We need it to survive. But it doesn't need to take over or get in the way of your life.
Now you have worked through this booklet, you have a better understanding of what anxiety is like for you, what the triggers are, and which behaviours are keeping it going. You now also know the strategies for keeping it in check. These take practice, so keep challenging yourself and watch your confidence grow. Sometimes, anxiety can pop up again (especially in times of stress like exams or around times of change). But as long as you can notice when you're getting pulled into the anxiety trap, you can use your strategies to get out again.
- KEEP NOTICING
Use your anxiety trap to develop an awareness of when anxiety is triggered, and what keeps it going. Mindfulness practice can also help with developing this skill (see our website for details).
- GO TOWARDS, NOT AWAY.
As tempting as it might be to run away from, or avoid, your fears, the only way to overcome them is to explore them. Be curious about them. Understand them more. Then plan your next move.
- CHOOSE A DIFFERENT RESPONSE.
Whichever safety behaviours you might be using, they will only work in the short-term. Test out whether or not the thoughts can be trusted by truing a different response to the anxious thoughts and feelings. If you don't try, you'll never know.
Lastly, you do not need to face anxiety alone. Ask a trusted friend or family member to support you with it, either through sharing your thoughts and feelings with them, or just celebrating with them after you've overcome one of your fears.
See our website: nsft.uk/cfypadvice
for links to useful websites and other resources for managing anxiety.
You may find some of our other Workbooks helpful too.