Anxiety Toolbox

Student Workbook

(434) 582-2651
Green Hall 1830
[Link]

Revised January 2017

This Anxiety Toolbox workshop curriculum is based on the Anxiety Toolbox curriculum at
Counseling Services of California Polytechnic State University, San Luis Obispo, with modifications
by the Broene Counseling Center of Calvin College. Used by permission.

Table of Contents

Welcome

Frequently Asked Questions

Session 1: Anxiety 101

Stress versus Anxiety ………………………………………………………………….. 6
Understanding Anxiety Disorders ………………………………………………... 7
Stress Curve ……………………………………………………………………………….. 8
Anxiety-Avoidance Roller Coaster ……………………………………………….. 8
Threat System (Fight or Flight) ……………………………………………………. 9
Common Anxiety Symptoms ……………………………………………………….. 10
Feelings Wheel …………………………………………………………………………… 11
Cross Sectional Formulation (example) ……………………………………….. 12
Cross Sectional Formulation (blank) ……………………………………………. 13
Breathing Exercises …………………………………………………………………….. 14
Sleep Hygiene ……………………………………………………………………………... 15
Homework Assignment ………………………………………………………………. 16
Cross Sectional Formulation (blank) ……………………………………………. 17

Session 2: Automatic Thoughts & Unhelpful Cognitions

Cross Sectional Formulation (example) ……………………………………….. 21
Unhelpful Thinking Styles …………………………………………………………… 22
Identifying Triggers Worksheet …………………………………………………… 23
Homework Assignment ………………………………………………………………. 24
Identifying Triggers Worksheet .………………………………………………….. 25
Cross Sectional Formulation (blank) ……………………………………………. 27

Session 3: Alternative Responses, Grounding, & Self-Care

Alternative Response Worksheet (example) ………………………………… 31
If You’re Having Trouble …….……………………………………………………….. 32
Alternative Response Worksheet (blank) …………………………………….. 34
Grounding Exercises …………………………………………………………………… 37
Pleasant Activities ………………………………………………………………………. 39
My Plan for Managing Anxiety ……………………………………………………... 40

Resources

2
 Welcome!

Welcome to Anxiety Toolbox, a fast-paced, 3-session workshop intended to help increase

your understanding and knowledge about anxiety. The goal is to provide you with some
skills to recognize and manage symptoms you may be experiencing. We hope you find it
helpful.

The goal of this workshop is to provide you with life-long tools you can use while facing
anxiety-triggering situations. Remember, this intervention is not intended to “get rid of”
your anxiety. While occasionally unpleasant, some anxiety can actually be a helpful and
motivating emotion. Our hope is that these three sessions provide you with a jumping
board from which to integrate skills into your daily life in the service of reducing anxiety.

By the end of this course, you will have received a lot of information, and at times it may
feel overwhelming. Remember that like any skill (e.g., learning to ride a bike), the skills you
will learn in Anxiety Toolbox take time and practice to master. At times, you may
encounter obstacles and/or find it difficult to integrate these skills into your daily life.
That’s okay – it’s how change works. And as with all change, it’s important to practice as
much as you can, even after encountering setbacks.

Think of your practice of these skills as a form of “mental health hygiene.” At the outset, it
may seem tedious and you may question why you need to practice these skills so often.
Think of it like dental hygiene—you brush your teeth multiple times a day to prevent the
buildup of plaque and ultimately to prevent cavities. Similar to brushing your teeth, daily
practice prevents a buildup of anxiety and stress over time. The more you practice and use
these skills as part of your daily routine, the less tedious they may seem because they
simply become a regular part of daily life.

A few guidelines to keep in mind…

• This workshop is confidential. Do not share information about anyone in the

workshop with others, including others’ stories (even if you think no one will know
whom you’re speaking about). We want to ensure that it feels safe to speak here.
• You are expected to attend all three sessions, as they build upon each other. If you
miss a session, you will be asked to switch to a different section of the workshop in
order to continue with the material in the proper order.
• Please be sure to let your workshop leader know (or call the counseling office)
ahead of time if you are unable to attend a session.

If at any time you feel that you need additional support, please let your workshop
leader know or contact Student Counseling Services at 434-582-2651. You can also
find additional resources online at [Link]/studentcounselingservices.

We’re glad you’re here!

3
 Frequently Asked Questions

What is Anxiety Toolbox?

Anxiety Toolbox is a fast-paced, 3-session workshop specifically designed to help people
who struggle with a variety of anxiety-related concerns (e.g., panic attacks, Generalized
Anxiety, test anxiety). The goal of this workshop is to provide education on anxiety and to
teach coping skills for managing anxiety symptoms.

Why does Anxiety Toolbox use a 3-session model?

Teaching Anxiety Toolbox over the course of 3 sessions allows you sufficient time to learn
the concepts, with time to practice between sessions. Keeping it to three 50-minute
sessions allows you to find time in your busy schedule to learn these skills.

What if I need more than 3 weeks to learn the model?

You are not alone. The skills taught in Anxiety Toolbox are difficult and take time to build.
For this reason, we offer multiple other groups, workshops, and resources that are
intended to provide further support for practicing these skills. For more information, talk
with your Anxiety Toolbox workshop leader or contact Student Counseling Services.

What if I don’t feel comfortable in groups?

Many people feel a little anxious about participating in a group. Anxiety Toolbox is
structured and curriculum-driven, like an academic class. You are not required to speak to
the entire group if you do not feel comfortable doing so. The facilitators respect each
participant’s right to share only what they are comfortable sharing and never require you
to share sensitive or potentially embarrassing information about yourself.

What if I have an urgent need to see a counselor during Anxiety Toolbox?

Simply let the workshop leader or the Student Counseling Services front desk staff know,
and they will facilitate you getting the support you need.

Why do I have to do homework?

The focus of this workshop is on building skills to cope with anxiety. In order to achieve
that goal, regular practice is essential. The more you practice, the more you may find you
get out of this workshop. The assignments are for you and only you, in the service of your
own personal growth. You will not be required to provide your responses at any time
during this workshop. However, it’s important to bring your responses as you may be
asked to look back on or elaborate on a prior assignment during the workshop.

What if I didn’t do my homework?

We encourage you to come to group regardless of whether or not you were able to
complete the homework assignment. We can also assist you in working on examples when
the homework is reviewed.

4
SESSION ONE

Anxiety 101

5
 Stress versus Anxiety

Everyday Anxiety (Stress) Anxiety Disorder

In response to a known environmental In response to an unknown source or in

factor response to the experience of stress

Symptoms go away when the stressor Symptoms remain despite no identifiable

goes away stressor

Worry about living away from home for Constant and unsubstantiated worry that
the first time, passing a class, a romantic causes significant distress and interferes
breakup, or other important life events with your daily life

Embarrassment or self-consciousness in Avoidance of social situations due to fear of

an uncomfortable or awkward social being judged, embarrassed, or humiliated
situation; feeling nervous about meeting
new people
Feeling nervous or sweating before a big Panic attacks that seem out of the blue and
test, class presentation, stage preoccupation with the fear of having
performance, or other significant event another one

Realistic fear of a dangerous object, place, Irrational fear or avoidance of an object,

or situation (e.g. fear of poisonous place, or situation that poses little or no
snakes) threat of danger (e.g. fear of elevators)
Making sure that you are healthy and Performing uncontrollable repetitive
living in a safe environment actions, such as excessive cleaning, checking,
touching or arranging

Adapted from: [Link]

6
 Understanding Anxiety Disorders

While anxiety is a normal and adaptive experience for everyone, anxiety disorders are
characterized by significant distress or impairment in social, academic/occupational, or
other important areas of functioning (e.g., your general ability to function in life).

Some of the most common anxiety disorders include:

Generalized Anxiety Disorder: Chronic and unrealistic worry that feels difficult to
control about everyday things (i.e., things that do
not worry most people)

Social Anxiety Disorder: Chronic worry solely related to social situations

Panic Disorder: Characterized by episodes of “panic” that include

things like: adrenaline surge, fear of losing control,
chest pain, racing heart, shortness of breath,
dizziness

Phobias: Specific fears that are excessive in nature and often

lead to avoiding that which is feared (e.g., public
speaking, heights, tunnels, etc.)

Obsessive-Compulsive Disorder: Excessive rumination (thinking) with repetitive

behaviors to reduce anxiety

7
 Yerkes Dodson Model of Stress Arousal & Performance

Anxiety - Avoidance Roller Coaster

Adapted from- [Link]

8
9
 Common Anxiety Symptoms

Physical Symptoms Cognitive Symptoms

 Increased heart rate  Fear of losing control, being
 Shortness of breath unable to cope

 Chest pain or pressure  Fear of physical injury or death

 Choking sensation  Fear of “going crazy”

 Dizziness, lightheadedness  Fear of negative evaluations by

others
 Sweating, hot flashes, chills
 Frightening thoughts, images, or
 Nausea, upset stomach, memories
diarrhea
 Perceptions of unreality or
 Trembling, shaking detachment
 Weakness, unsteadiness,  Poor concentration, confusion,
faintness distractibility
 Tense muscles, rigidity  Narrowing of attention,
 Dry mouth hypervigilance for threat
 Other: ________________________  Poor memory
 Difficulty in reasoning, loss of
objectivity
Behavioral Symptoms
 Other:___________________________
 Avoidance of threat cues or
situations
 Escape, flight Emotional Symptoms
 Pursuit of safety, reassurance  Feeling nervous, tense, wound
up
 Restlessness, agitation, pacing
 Feeling frightened, fearful,
 Hyperventilation
terrified
 Freezing, motionlessness
 Being edgy, jumpy, jittery
 Difficulty speaking  Being impatient, frustrated
 Other:___________________________  Other: __________________________

Adapted from The Anxiety and Worry Workbook by Clark and Beck

10
Feelings Wheel

11
 Cross Sectional Formulation (example entry)
Situation (When? Where? What? With whom? What did you feel anxious about?)
A student invited me to a party in my residence hall, but I didn’t know
her very well and felt anxious about going.

Physical (When anxious, what physical

sensations did you experience? What did you
notice in your body?)

Heart racing, tight chest,

shallow breathing, hot

Emotional (What emotions Cognitive (What went

came up for you when you felt through your mind when you
anxious?) felt anxious? What did that say
or mean about you or the
Scared, ashamed, situation?)
Lonely, agitated,
nervous I won’t know anyone at
the party and will feel
awkward. No one will
like me because I’m so
socially awkward. I
won’t have fun. But if
I say no, this person
won’t like me and I
wouldn’t make friends.

Behavioral (What was your first instinct

and/or automatic response? What did you
do and/or avoid doing at the time?)

My first instinct was to say no.

I avoided saying no but telling
her that I would think about it.
I never got back to her. I
didn’t go to the party.

12
 Cross Sectional Formulation
Situation (When? Where? What? With whom? What did you feel anxious about?)

Physical (When anxious, what physical

sensations did you experience? What did you
notice in your body?)

Emotional (What emotions Cognitive (What went

came up for you when you felt through your mind when you
anxious?) felt anxious? What did that say
or mean about you or the
situation?)

Behavioral (What was your first instinct

and/or automatic response? What did you
do and/or avoid doing at the time?)

13
 Breathing Exercises

Belly (or Diaphragmatic) Breathing

You can do this exercise in any position, but it is helpful to do this exercise while lying
down when first learning belly breathing.
1. Lie comfortably on your back, with a pillow under your head, your knees bent and your
back flat. You can stretch your legs out if that's more comfortable.
2. Place one hand on your belly and one hand on your upper chest.
3. Inhale slowly and expand your belly as you breathe so that your lower hand moves with
your belly. The hand on your chest should remain as still as possible.
4. Slowly exhale, focusing on the movement of your belly and lower hand as it returns to
its original position.
5. Repeat steps 3 & 4 for several minutes, always focusing on the movement of the belly as
you breathe. If your mind wanders, gently bring your attention back to your breathing.

Breath-Counting Exercise
This exercise focuses on the use of counting with the rhythm of the breath. Start with a
short period of time and gradually increase the time. Set a timer so that you do not have to
worry about when to stop.
1. Find a comfortable position. Take several deep breaths and settle into yourself. You
may either close your eyes or keep them open, depending on your own comfort. If you
keep them open, fix them on an object or a spot on the floor about four feet in front of
you. Your eyes may be either focused or unfocused.
2. Take deep, comfortable breaths. Notice your inhalation. The pause between inhaling
and exhaling, your exhalation, and the pause before starting again.
3. As you inhale, count, “one...” As you exhale, count, “two...” Inhale, “three...” Exhale,
“four...” Continue until you reach 10 then start over.
4. If you lose count, simply begin with “one” on your next inhalation.
5. If you notice your mind has wandered, gently notice this, and return your focus back to
counting your breath.
6. If you notice any body sensations catching your attention, focus on that sensation until
it fades. Then return your attention back to counting your breaths.

14
 Sleep Hygiene

What is Sleep Hygiene? ‘Sleep hygiene’ is the term used to describe good sleep
habits. Considerable research has gone into developing a set of guidelines and tips
which are designed to enhance good sleeping, and there is much evidence to suggest
that these strategies can provide long-term solutions to sleep difficulties.

1. Get regular. Go to 7. The right space. Make your bed and

bed and get up at bedroom quiet and comfortable for
more or less the same sleeping. An eye mask and earplugs
time every day, even may help block out light and noise.
on weekends and days off! 8. No naps. Avoid taking naps during the
2. Get up & try again. Go to sleep only day. If you can’t make it through the
when tired. If you haven’t been able to day without a nap, make sure it is for
fall asleep after 30 minutes, get up and less than an hour and before 3pm.
do something calming (not stimulating) 9. Sleep rituals. Develop rituals to
until you feel sleepy, then return to bed remind your body
and try again. that it is time to
3. Avoid caffeine & nicotine. Avoid sleep, like relaxing
consuming any caffeine stretches or
(coffee, tea, soda, chocolate) or breathing exercises
nicotine (cigarettes) for at for 15 minutes before bed.
least 4-6 hours before going to 10. No clock-watching. Checking the clock
bed. These act as stimulants during the night can wake you up and
and interfere with falling asleep reinforces negative thoughts such as
4. Avoid alcohol. Avoid alcohol for at “Oh no, look how late it is, I’ll never get
least 4-6 hours before bed because it to sleep.”
interrupts the quality of sleep.
11. Keep daytime routine the same.
5. Bed is for sleeping. Do not t to use Even if you have a bad night sleep it is
your bed for anything other than important that you try to keep your
sleeping and sex, so that your body daytime activities the same as you had
comes to associate bed with sleep. planned. That is, don’t avoid activities
6. Electronics Curfew. because you feel tired. This can
Don’t use back-lit reinforce the insomnia.
electronics 60 minutes
prior to bed, as the
artificial light prevents hormones and Adapted from [Link]
neurons that promote sleep.

15
 Session 1: Homework Assignment

Homework 1
Complete at least 1 simple Cross-Sectional Formulation worksheet for review next week.
 multiple blank copies provided starting on page 14

Homework 2
Practice Deep Breathing.
 place one hand on stomach and one on chest – as you breathe, imagine using the
air you breathe in to push against the hand on your stomach
 take a deep breath in through the nose, counting as you inhale: 1…2…3…4…
 hold for a count of 2
 exhale through the mouth, as if you are blowing out a candle, counting as you
exhale: 1…2…3…4…
 pause and repeat

Homework 3
Implement 1 sleep hygiene tip.
 see page 12

16
 Cross Sectional Formulation
Situation (When? Where? What? With whom? What did you feel anxious about?)

Physical (When anxious, what physical

sensations did you experience? What did you
notice in your body?)

Emotional (What emotions Cognitive (What went

came up for you when you felt through your mind when you
anxious?) felt anxious? What did that say
or mean about you or the
situation?)

Behavioral (What was your first instinct

and/or automatic response? What did you
do and/or avoid doing at the time?)

17
 Cross Sectional Formulation
Situation (When? Where? What? With whom? What did you feel anxious about?)

Physical (When anxious, what physical

sensations did you experience? What did you
notice in your body?)

Emotional (What emotions Cognitive (What went

came up for you when you felt through your mind when you
anxious?) felt anxious? What did that say
or mean about you or the
situation?)

Behavioral (What was your first instinct

and/or automatic response? What did you
do and/or avoid doing at the time?)

18
 Cross Sectional Formulation
Situation (When? Where? What? With whom? What did you feel anxious about?)

Physical (When anxious, what physical

sensations did you experience? What did you
notice in your body?)

Emotional (What emotions Cognitive (What went

came up for you when you felt through your mind when you
anxious?) felt anxious? What did that say
or mean about you or the
situation?)

Behavioral (What was your first instinct

and/or automatic response? What did you
do and/or avoid doing at the time?)

19
 SESSION TWO

Automatic Thoughts
&
Unhelpful Cognitions

20
 Cross Sectional Formulation (example)

Situation (When? Where? What? With whom? What did you feel anxious about?)
A student invited me to a party in my residence hall, but I didn’t
know her very well and felt anxious about going.

Physical (When anxious, what physical

sensations did you experience? What did you
notice in your body?)

Heart racing, tight chest,

shallow breathing, hot

Emotional (What emotions Cognitive (What went

came up for you when you felt through your mind when you
anxious?) felt anxious? What did that say
or mean about you or the
Scared, ashamed, situation?)
Lonely, agitated,
nervous I won’t know anyone at
the party and will feel
awkward. No one will
like me because I’m so
socially awkward. I
won’t have fun. But if
I say no, this person
won’t like me and I
wouldn’t make friends.

Behavioral (What was your first instinct

and/or automatic response? What did you
do and/or avoid doing at the time?)

My first instinct was to say no.

I avoided saying no but telling
her that I would think about it.
I never got back to her. I
didn’t go to the party.

21
22
 Identifying Triggers Worksheet (In-session)

While at times it may be difficult to identify a trigger, understanding your triggers for
anxiety is an important step in helping you know when to implement and/or emphasize
practice of the coping strategies you will learn in Anxiety Toolbox. Triggers can be external
events (e.g., a test) or internal stimuli (e.g., a physical sensation or emotion) that led to your
experience of anxiety (i.e., the emotional, physical, cognitive, and behavioral symptoms
previously discussed during this workshop). Remember that sometimes the symptoms
themselves can be a trigger that starts the cycle of anxiety.

The following are some typical categories in which triggers might appear with examples:

Responses to Internal Stimuli:

 Emotions: e.g., feeling down, fear or worry
 Mental Images: e.g., replaying interpersonal interactions or performance experience
 Physical State: e.g., racing heartbeat, lightheadedness, tightness in chest
 Thoughts: e.g., “I might fail this test”, “That person must not like me”, “If someone talks
to me in class, I won’t be able to handle it.”

Responses to External Stimuli:

 Presence of Others: e.g., attending a social event, meeting with a professor, spending
time with roommates, family interactions
 Physical Setting: e.g., a classroom, open areas on campus, inside a car
 Social Pressure: e.g., feeling pressured to make friends, feeling pressured to perform
well in school (in comparison to your peers)
 Activities: e.g., a sports event, a party, going home for the weekend

List some triggers you experience related to your anxiety:

1._______________________________________________________________________________________________

2._______________________________________________________________________________________________
3._______________________________________________________________________________________________
4._______________________________________________________________________________________________
5._______________________________________________________________________________________________

23
 Session 2: Homework Assignment

Homework 1
Complete Identifying Triggers Worksheet on pages 22-23.

Homework 2
Complete at least 1 simple Cross Sectional Formulation worksheet for review next week.
 multiple blank copies provided starting on page 24

24
 Identifying Triggers Worksheet (Homework)

Pay attention to any triggers for anxiety that you may experience over the next week.
Write them down in the following categories. You may have triggers in all of the categories
or you may notice triggers in only one or two categories. (Use the “other” category for
triggers you feel don’t fit in the options listed.)

Emotions:
1.________________________________________________________________________________________
2.________________________________________________________________________________________
3.________________________________________________________________________________________

Mental Images:
1.________________________________________________________________________________________
2.________________________________________________________________________________________
3.________________________________________________________________________________________

Physical States:
1.________________________________________________________________________________________
2.________________________________________________________________________________________
3.________________________________________________________________________________________

Thoughts:
1.________________________________________________________________________________________
2.________________________________________________________________________________________
3.________________________________________________________________________________________

25
Presence of Others:
1.________________________________________________________________________________________
2.________________________________________________________________________________________
3.________________________________________________________________________________________

Physical Setting:
1.________________________________________________________________________________________
2.________________________________________________________________________________________
3.________________________________________________________________________________________

Social Pressure:
1.________________________________________________________________________________________
2.________________________________________________________________________________________
3.________________________________________________________________________________________

Activities:
1.________________________________________________________________________________________
2.________________________________________________________________________________________
3.________________________________________________________________________________________

Other:
1.________________________________________________________________________________________
2.________________________________________________________________________________________
3.________________________________________________________________________________________

26
 Cross Sectional Formulation
Situation (When? Where? What? With whom? What did you feel anxious about?)

Physical (When anxious, what physical

sensations did you experience? What did you
notice in your body?)

Emotional (What emotions Cognitive (What went

came up for you when you felt through your mind when you
anxious?) felt anxious? What did that say
or mean about you or the
situation?)

Behavioral (What was your first instinct

and/or automatic response? What did you
do and/or avoid doing at the time?)

27
 Cross Sectional Formulation
Situation (When? Where? What? With whom? What did you feel anxious about?)

Physical (When anxious, what physical

sensations did you experience? What did you
notice in your body?)

Emotional (What emotions Cognitive (What went

came up for you when you felt through your mind when you
anxious?) felt anxious? What did that say
or mean about you or the
situation?)

Behavioral (What was your first instinct

and/or automatic response? What did you
do and/or avoid doing at the time?)

28
 Cross Sectional Formulation
Situation (When? Where? What? With whom? What did you feel anxious about?)

Physical (When anxious, what physical

sensations did you experience? What did you
notice in your body?)

Emotional (What emotions Cognitive (What went through

came up for you when you felt your mind when you felt anxious?
anxious?) What did that say or mean about
you or the situation?)

Behavioral (What was your first instinct

and/or automatic response? What did you
do and/or avoid doing at the time?)

29
 SESSION THREE

Alternative Responses,
Grounding, & Self-Care:
Putting It All
Together

30
 Alternative Response Worksheet (example)
Situation: (When? Where? What? With whom? What did you feel anxious
about?)
A student invited me to a party in my residence hall, but I
didn’t know her very well and felt anxious about going.

Alternative Thoughts Alternative Behaviors: Alternative Feelings:

and Images: (Are these (What could you do that (What are feelings that
thoughts helpful? Are would be more helpful are more helpful? What
the anxious thoughts for you, others, &/or the if you acted and thought
100% true/accurate, situation? What are differently about the
100% of the time? What coping strategies that situation? How might
are other ways of might be helpful?) these changes help you
looking at this? What is feel differently?)
the bigger picture? ) Coping Strategies I
Can Use: Excited

 Deep breathing Wanted
I may not be as
socially awkward as  Distract myself Liked
I think.
 Seek support from Hopeful
If she invited me, a friend/ family
she probably wants member
me there.
 Do a pleasurable
I might still have activity
an okay time, even
if I am anxious.
 Use alternative

response
worksheet

Original Outcome: (What was the original outcome?)

I stayed in my room and watched Netflix.

Desired Outcome: (Using these new alternatives, what would you like the
outcome to be in the future?)
I want to go to the party so that I can make friends. If I feel
too uncomfortable, I can always leave.

31
 If you're having trouble, ask yourself these questions:
Whenever we recognize an anxiety-related thought, feeling or behavior, it can be very
helpful to ask ourselves the following questions:

Alternative THOUGHTS:
1. What are other ways of looking at this situation?
2. Am I looking at the whole picture?
3. What might be a more helpful way of picturing this situation?
4. What unhelpful thinking styles might I be using here (see below)?
5. What is the evidence that my thoughts are true? Is there an alternative way of thinking
about this situation that is more true?
6. What is the probability that my thoughts will happen? What are some other things that
could happen that are equally, if not more, probable?
7. Have I had any experiences in the past that suggests that this thought might not be
COMPLETELY true ALL of the time?
8. Can I really predict the future? Is it helpful to try? What is more helpful?
9. Am I exaggerating how bad the result might be? What is more realistic?
10. Can I read people’s minds? What else might they be thinking (that’s not so negative)?
11. If a friend or loved one were in this situation and had this thought, what would I tell
them?

Common Cognitive Distortions (Unhelpful Thinking Styles)

All or Nothing Thinking: thinking in Over-generalizing: seeing a pattern based upon
absolute, black and white categories a single event or being overly broad in
conclusions we draw
Mental Filter: only paying attention Disqualifying the positive: discounting the
to certain types of evidence (e.g., good things that have happened
dwelling on the negatives)
Jumping to Conclusions: Magnification (catastrophizing) and
Mind reading: imagining we know minimization: blowing things out of proportion
what others are thinking or inappropriately shrinking something to make
Fortune telling: predicting the future it seem less important
Emotional Reasoning: assuming Should/Must Thinking: Using words like
because we feel a certain way, what “should”, “must”, “ought to” or “have to”
we think must be true
Labeling: assigning labels to Personalization: blaming yourself for
ourselves or others something you weren’t entirely responsible for
OR blaming others and overlooking ways you
may have contributed to the outcome

32
Alternative BEHAVIORS:
1. What could I do in the moment that would be more helpful?
2. What’s the best thing to do (for me, for others, or for the situation)?
3. If my feared situation happens, how will I cope? What coping skills can I use to handle
my feared situation? What have I done in the past that was successful?
4. Am I needing to work on acceptance, letting go of control, being okay with less than
perfect, or having faith in the future and myself?
5. Breathe: Focus your attention on your breathing. Imagine you have a balloon in your
belly, inflating on the in-breath, deflating on the out-breath.

Alternative FEELINGS:
1. What might it feel like if I acted/thought differently?
2. When I’m not feeling this way, do I think about this situation differently?
3. Are there any strengths or positives in me or the situation that I might be ignoring?
4. What else might this anxiety be related to? Is it really about feeling _______?
5. Tell yourself: “This feeling will pass. It’s a normal body reaction.”

33
 Alternative Response Worksheet
Situation (When? Where? What? With whom? What did you feel anxious about?)

Alternative Thoughts and Alternative Behaviors: Alternative Feelings:

Images: (Are these (What could you do that (What are feelings that are
thoughts helpful? Are the would be more helpful for more helpful? What if you
anxious thoughts 100% you, others, &/or the acted and thought
true/accurate, 100% of the situation? What are coping differently about the
time? What are other ways strategies that might be situation? How might these
of looking at this? What is helpful?) changes help you feel
the bigger picture? ) differently?)
Coping Strategies I Can
Use:
 Deep breathing
 Distract myself
 Seek support from a
friend/ family
member
 Do a pleasurable
activity
 Use alternative
response worksheet




Original Outcome: (What was the original outcome?)

Desired Outcome: (Using these new alternatives, what would you like the outcome to be in
the future?)

34
 Alternative Response Worksheet
Situation (When? Where? What? With whom? What did you feel anxious about?)

Alternative Thoughts and Alternative Behaviors: Alternative Feelings:

Images: (Are these (What could you do that (What are feelings that are
thoughts helpful? Are the would be more helpful for more helpful? What if you
anxious thoughts 100% you, others, &/or the acted and thought
true/accurate, 100% of the situation? What are coping differently about the
time? What are other ways strategies that might be situation? How might these
of looking at this? What is helpful?) changes help you feel
the bigger picture? ) differently?)
Coping Strategies I Can
Use:
 Deep breathing
 Distract myself
 Seek support from a
friend/ family
member
 Do a pleasurable
activity
 Use alternative
response worksheet




Original Outcome: (What was the original outcome?)

Desired Outcome: (Using these new alternatives, what would you like the outcome to be in
the future?)

35
 Alternative Response Worksheet
Situation (When? Where? What? With whom? What did you feel anxious about?)

Alternative Thoughts and Alternative Behaviors: Alternative Feelings:

Images: (Are these (What could you do that (What are feelings that are
thoughts helpful? Are the would be more helpful for more helpful? What if you
anxious thoughts 100% you, others, &/or the acted and thought
true/accurate, 100% of the situation? What are coping differently about the
time? What are other ways strategies that might be situation? How might these
of looking at this? What is helpful?) changes help you feel
the bigger picture? ) differently?)
Coping Strategies I Can
Use:
 Deep breathing
 Distract myself
 Seek support from a
friend/ family
member
 Do a pleasurable
activity
 Use alternative
response worksheet




Original Outcome: (What was the original outcome?)

Desired Outcome: (Using these new alternatives, what would you like the outcome to be in
the future?)

36
 Grounding Exercises

When people become overwhelmed with distressing thoughts or feelings, including intense
anxiety, activities that keep your mind and body connected (called “grounding”) can be
helpful in regaining a sense of stability and mental focus. The following are a number of
grounding exercises to choose from to help firmly anchor you in the present moment and
provide you with space to choose where to focus your energy. You may need to try
multiple different exercises to find one or two that work best for you.

1. Remind yourself of who you are now. State your name, age and where you are right
now.
2. Take ten slow deep breaths. Focus your attention on each breath on the way in and
on the way out. Say the number of the breath to yourself as you exhale.
3. Splash water on your face or place a cool wet cloth on your face.
4. Pay purposeful attention as you hold a cold (non-alcoholic) beverage in your hands.
Feel the coldness, and the wetness on the outside. Note the taste as you drink. You can
also do this exercise with a warm beverage.
5. Find a “grounding object” to hold, look at, listen to, and/or smell. This could be a soft
object such as a pillow or stuffed animal, a smooth stone you found on the beach, a
picture of a beautiful scene or loved one, and/or any other object that represents
safety or comfort.
6. Listen to music. Pay close attention and listen for something new or different.
7. If you wake up suddenly during the night and feel disoriented or distressed, remind
yourself who you are and where you are. Look around the room and notice familiar
objects and name them. Feel the bed you are lying on, the softness of the sheets or
blankets, the warmth or coldness of the air, and notice any sounds you hear. Remind
yourself that you are safe.
8. Feel the clothes on your body, whether your arms and legs are covered or not, and the
sensation of your clothes as you move in them.
9. While sitting, feel the chair under you and the weight of your body and legs pressing
down on it.
10. If you are lying down, feel the contact between your head, your body and your legs, as
they touch the surface you are lying on. Starting from your head, notice how each part
feels, all the way down to your feet, on the soft or hard surface.
11. Stop, look, and listen. Notice and name what you can see and hear nearby and in the
distance.
12. Look around you, notice what is front of you and to each side, name first large objects
and then smaller ones.
13. Get up, walk around, take your time to notice each step as you take one then another.
14. If you can, step outside, notice the temperature, the sounds around you, the ground
under your feet, the smell in the air, etc.

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15. “54321” Grounding Exercise:
o Name 5 things you can see in the room with you.
o Name 4 things you can feel (tactile; e.g. “chair on my back” or “feet on floor”)
o Name 3 things you can hear right now
o Name 2 things you can smell right now
o Name 1 good thing about yourself
16. Write and/or say grounding statements
o This situation won’t last forever
o This too shall pass.
o I can ride this out and not let it get me down.
o My anxiety/fear/sadness won’t kill me; it just doesn’t feel good right now.
o These are just my feelings and eventually they’ll go away.

Adapted from: [Link]

38
 Pleasant Activities

Acting Amusing Attending a Beachcombing Being alone Being with Being at the
people concert animals beach
Being Being coached Being Being in the Being at a Being with Being with
complimented counseled country family get- friends happy
together people
Being in the Being with my Being with Being told I am Being with my Bird- Boating/
mountains roommate someone I loved parents watching canoeing
love
Budgeting my Buying things Buying Camping Caring for Canning/ Cheering for
time for myself something for plants Making something
someone I preserves
care about
Collecting Combing/ Completing a Complimenting Cooking Counseling Dancing
things brushing my difficult task or praising someone
hair someone
Dating Designing/ Discussing my Doing art work Doing Doing favors Doing
someone I like Drafting favorite hobby experiments for people I housework
like
Dreaming at Drinking Driving long Eating good Exploring/ Expressing Feeling the
night something distances meals Hiking love to presence of
warm someone God

Fishing Fixing Gardening/ Gathering Giving gifts Giving a Getting up

machines Doing natural objects party for early
yardwork someone
Getting Giving Going to an Going to a Going to a Going to Going to a
massages massages amusement barber/ concert lectures luncheon/
park/ zoo beautician potluck
Going to a Going to the Going to a Going on Going to a play Going to a Going to a
health club/ movies museum nature walks/ restaurant reunion
sauna/spa field trips
Going to a Going to a Having Having Having friends Having a Having lunch
spiritual/ sports event coffee/tea daydreams over to visit lively talk with friends
peaceful place with friends
Having an Having spare Hearing jokes Helping Hiking Horseback Improving
original idea time someone riding my health
Kicking sand/ Knitting/ Laughing Learning Listening to Listening to Looking at
pebbles/leaves crocheting something new the ratio music the stars/
moon
Making Making food Making a new Meditating/ Planning or Playing Playing
charitable to give away friend Doing yoga organizing sports cards
donations something
Playing music Playing with a Playing in Playing a Photography Praying Repairing
pet nature board game/ things
chess
Reading Reminiscing Riding in an Running/ Seeing Seeing old Sewing
airplane jogging beautiful friends
scenery
Shaving Singing Sleeping late Smelling a Seeing good Solving a Speaking a
flower or plant things happen puzzle/ foreign
to people crossword language

Staying up late Smiling at Snuggling Taking a bath Using my Watching TV Writing in a

people under a strengths journal
blanket

39
 My Plan for Managing Anxiety
Putting it all Together

1. My primary anxiety symptoms include:

a. Emotional:

b. Physical:

c. Cognitive:

d. Behavioral:

2. Some of my unhelpful ways of thinking are: (e.g., all or nothing thinking,

catastrophizing, etc.)

3. My situational and cognitive triggers are: (e.g., unfamiliar situations, negative thoughts,
etc.)

4. The most helpful grounding technique(s):

5. The most helpful relaxation exercise(s):

6. The best time and place to practice relaxation exercises:

40
7. When I feel overwhelmed, it is helpful for me to:

8. Positive changes I can make to help my sleep include: (e.g., no TV 30 minutes before
bed, wake up at the same time daily, turn phone off, etc.)

9. MY GOALS: Name 2 goals you would like to achieve over the next few months, related
to anxiety and self-care. Think: specific, achievable, and measurable.
a. Name 2 goals you would like to achieve related to ANXIETY (e.g., Thinking about the
strategies you find most helpful, what would you like to try, how often, when, etc.?)
i. ______________________________________________________________________

ii. ______________________________________________________________________

b. Name 2 goals you would like to achieve related to SELF-CARE: (What will your self-
care look like over the next few months? These could be goals related to nutrition,
exercise, sleep, schoolwork, leisure activities, etc.)
i. _______________________________________________________________________

ii. ________________________________________________________________________

How can I remind myself about my plan and goals?

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

41
 ADDITIONAL RESOURCES
Online

Cal Poly SLO Counseling Services - Guided Meditations

[Link]/playlist?list=PLI44jVzqiSNuYrPNPWHc6BTqrwBXtlhrS
Mayo Clinic Stress Reduction Website
[Link]/health/mindfulness-exercises/MY02124
Meditation Oasis
[Link]
Mindful
[Link]
Mindfulness Research Guide
[Link]/
The Mindful Christian
[Link]
UCLA Mindful Awareness Research Center- Guided Meditations
[Link]/[Link]?id=22

Apps for your Smartphone, Tablet, or Computer

ACT Coach Mindfulness Coach
Breathe2relax Mindshift
Breathing techniques by Hemalayaa T2 Mood Tracker
CBTi-Coach Take a break!

Books
The Anxiety and Phobia Workbook by Bourne (2011)
The Anxiety and Worry Workbook by Clark & Beck (2012)
Get Out of Your Mind and Into Your Life by Hayes & Smith (2005)
Self-Esteem by McKay and Fanning (2005)
The Mindful Way Workbook by Teasdale, Williams, Segal, & Kabat-Zinn (2014)
The Mindfulness Workbook: A Teach Yourself Guide by Langley (2013)
The Relaxation & Stress Reduction Workbook by Davis, Robbins, Eshelman & McKay (2008)

42