Ansiedade Recuperação

© COPYRIGHT NOTICE
Caroline Stewart & Robin Hall

Overcome Panic Attacks & Agoraphobia
Workbook 2 - Rapid Recovery Skills
© 2010 Caroline Stewart & Robin Hall

website: www.cognitivetherapyonline.com
email: info@cognitivetherapyonline.com
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Step 2.
Rapid Recovery
Skills
“If I had more skill in what I’m attempting,
I wouldn't need so much courage”
Ashleigh Brilliant
3
The key to TOTAL
and ABSOLUTE
Recovery
When you lose your fear of panic

IT WILL STOP HAPPENING
To lose your fear you have to PROVE to yourself that

panic CANNOT do you any ACTUAL harm
To DO that you have to eventually be able to

experience the feelings and sensations
and put your new understanding to the TEST
The following
Cognitive and Behavioural Skills
will help you do just that!
4
R APID RECOVERY SKILLS
The PROBLEM The SOLUTION
Harmless but Frightening 1 KNOWLEDGE

Fight or Flight Symptoms about Fight or Flight
(which aren’t REALLY the problem) Misinterpretation
Catastrophisation
& the fear cycles
MISINTERPRETATION
CATASTROPHISATION 2 SKILLS
of the symptoms Learn Cognitive and
Behavioural techniques
that will enable you to
PANIC Cycle
CHALLENGE THE BELIEF
in the Misinterpretation
ANTICIPATORY Anxiety
Cycle 3 GRADUATED
EXPOSURE PRACTICE
SAFETY BEHAVIOUR Gradually face the bodily
Cycle sensations and situations
and drop Safety Behaviour
AVOIDANCE Cycle in order to TEST
the new information
5
U N D E R S T A N D I N G PA N I C
Important!
These skills are NOT to help you
AVOID panic attacks
These are NOT ‘relaxation’,

‘distraction’ or ‘avoidance’ techniques
Your goal is to NOT CARE if you panic or not

because panic cannot cause you any ‘actual’ harm.
When you are no longer afraid of panic attacks

THEY WILL STOP HAPPENING..
since it is your FEAR that keeps them going
These skills will help you FACE (and so reduce)

your panic in a manageable way
That is the ONLY way you can REALLY learn

that the sensations are just harmless (although frightening)
symptoms of anxiety which will die down if left alone.
6
Rapid Recovery Skills
Part 1.
Change the way you THINK!
Challenging the
MISINTERPRETATIONS!
"Supposing a tree fell down, Pooh, when we were

underneath it?" said Piglet.
"Supposing it didn't," said Pooh after careful thought.

A. A. Milne
7
Correcting mistaken beliefs ABOUT

panic reduces our FEAR of panic
and when we have less fear of panic
it will stop happening..
‘Positive thinking’ isn’t enough
If your heart is beating rapidly and you say to yourself “I’m sure I’ll be ok”..
there may not be enough BELIEF in that thought to reduce your fear.
You need to replace your mistaken

Catastrophic Thoughts about panic
with the actual TRUTH about the
symptoms.
If you bring to mind the ACTUAL

TRUTH about your rapid heart beat -
- that it is just a result of the fight or

flight response and you are in no danger
whatsoever -
the stronger belief in those thoughts will

help stop further ‘misinterpretation’ and
‘catastrophising’ and your symptoms
will die down.
8
There are 4 STEPS to changing the way

you think about panic..
CATCH IT
1 - IDENTIFY the
unhelpful thoughts
(Misinterpretations)
Miss Interpret Mr Catastrophise
CHALLENGE IT
2 - CHALLENGE those
thoughts - look at the
EVIDENCE
CHANGE IT
3 - CORRECT the thoughts -
RESTRUCTURE them
based on ACTUAL EVIDENCE
TEST IT
4 - Put the restructured thoughts
to the TEST with
Graduated Exposure Practice
(we will do this in Chapter 3) 9
CATCH IT
Identify the unhelpful thoughts
Very often it seems like we didn’t ‘think’ anything - we just ‘felt’ terrible.
But if you go over the experience carefully you will be able to uncover
some of the thoughts that went through your mind.
Many people aren’t even aware that thoughts are flashing through their
mind faster than the speed of light especially during a panic attack.
Consider the following questions...
What were you thinking
BEFORE - DURING and AFTER the panic attack?
• Were you thinking any anxious thoughts prior to the panic?

• What did you think when you felt the first symptoms of anxiety?
• Did you think about stopping the anxiety or leaving the situation?
• Did you ‘worry’ about what might happen next?
• Did you worry about WHY the symptoms were happening?
• Did you think about what other people might think?
• Did you ‘worry’ about the panic attack after it died down?
• Did you worry about having another attack in the future?
10
What are you REALLY afraid of?..

How to find the hidden fearful thoughts
The ‘downward arrow technique’
Many of our anxious thoughts are ‘surface level’ thoughts - thoughts
that arise as a RESULT of our underlying fear which we may not even be
consciously aware of.
For instance, if you panic in a shop you may think “I need to get out of
here” - that thought is NOT the ‘fear’ thought - it is the ‘escape’ thought.
The fear thought would be the deeper thought that is CAUSING you to feel
a need to escape..
Downward Arrow Technique
SURFACE THOUGHT
‘I need to get out of here’
WHY? What do you think will happen if you DON’T get out?
DEEPER ‘FEAR’ THOUGHT
‘I will collapse’
And what do you fear most about collapsing?

EVEN DEEPER ‘FEAR’ THOUGHT/S
‘Everyone will think I an insane.’
‘They will have to carry me out.’
‘It will be a complete disaster.’
11
DOWNWARD ARROW TECHNIQUE - QUESTIONS
Our deeper fears can vary according to whatever situation we are in. We may be
fearful about our physical health, our mental health, what other people are thinking,
our future and so on. In each case a particular question may help you uncover the
deeper fear.
QUESTIONS to help take you to the ROOT thought

What do you think will happen?
Why would that be so bad? - Why would that be so catastrophic?
What would that say about you? - your life
What is the worst that you think will happen?
EXAMPLES
Anxious in a crowd Feeling you will collapse in shopping centre
I’m going to lose control My legs are so weak I won’t make it
Everyone will think I am crazy Someone will need to rescue me
They will have to call for a doctor I will be totally embarrassed

I can’t bear the humiliation
Fear of panic attack in a shop I can’t climb that many stairs
I can’t go into the shop I can’t climb that many stairs
I will have a panic attack I will become fatigued
That will set off many panic attacks it will cause me to panic and then i
for days to come will be in panic for a long time.
12
DOWNWARD ARROW TECHNIQUE - MORE EXAMPLES
Feeling of Derealisation After you have been feeling okay for a while
I need to stop this feeling of unreality I won’t go to that party
The feeling will overwhelm me It may trigger a panic attack
I will lose my mind completely I will go back to the way I was and
and feel terrified FOREVER will stay that way for a long time
Feeling a need to control a physical symptom Fear of driving on the motorway
I need to control my shaking hand The motorway is too scary
The assistant will see I am nervous I will have a panic attack
They will think I am weak No one will be able to help me - I

and pathetic will crash or be trapped in the car
13
DOWNWARD ARROW TECHNIQUE
WORKSHEET
SURFACE LEVEL PANIC THOUGHTS
QUESTIONS to help take you to the ROOT thought

What do you think will happen?
Why would that be so bad? - Why would that be so catastrophic?
What would that say about you? - your life
What is the worst that you think will happen?
UNDERLYING FEARFUL THOUGHTS
14
Identifying thoughts using a

Panic Sequence Profile
A great way to observe how a panic attack unfolds is to use a
PANIC SEQUENCE PROFILE.
Pick a recent panic attack episode and break it down into a

sequence of events. What was the situation - note the time and
place. Then put down in order exactly what happened.
Note the physical sensations, exact thoughts and behaviour AS

THEY HAPPENED - then note what TYPE of reaction each was -
ie. Catastrophising / Misinterpreting / Avoidance / Safety
Behaviour / Anticipatory Anxiety / Physical Symptom
This enables you to see how your thoughts or behaviour added

to the escalation of the panic.
Look at the example profiles on the next few pages..
WHAT S
EN
HAPP ?
NEXT
15
PA N I C S E Q U E N C E P R O F I L E - 1 TYPE OF REACTION
if. Catastrophising
SITUATION / TIME / PLACE Misinterpreting
Sitting in restaurant - just about to start meal

Avoidance / Escape
Safety Behaviour
Anticipatory Anxiety
Physical Symptom
ANY OBSERVATIONS PRIOR TO PANIC
I had been worried about going to the restaurant all Anticipatory Anxiety
day in case I had a panic attack
HOW THE PANIC ATTACK UNFOLDED

(Physical sensations / Thoughts / Behaviour)
felt my heart fluttering Physical Symptom
thought I was going to have a heart attack or Misinterpreting

collapse in front of everyone Catastrophising
felt even more frightened then began to sweat and Increase of
felt a bit dizzy Physical Symptom
Was convinced there was something seriously wrong Misinterpreting

Catastrophising
Thought I had to get out right away Escape - Avoidance
left the Restaurant and went home Safety behaviour
lay down as soon as I reached home Safety behaviour
Worried about it all night and ever since Anticipatory Anxiety
THOUGHTS / BEHAVIOUR AFTER THE PANIC

Haven’t gone back to any restaurant Safety behaviour
16
PA N I C S E Q U E N C E P R O F I L E - 2 TYPE OF REACTION
if. Catastrophising
In bed - woke up felt ‘strange’

Avoidance / Escape
Safety Behaviour
Physical Symptom
I felt a but ‘jittery’ during the day and WAS a bit Anticipatory Anxiety
worried incase I couldn’t sleep

as soon as I woke up my arm felt numb Physical Symptom
thought I was going to lose all feeling in it Misinterpreting

Catastrophising
Got up quickly and turned on the light Physical Symptom
heart started beating rapidly
thought I was going to lose control completely Misinterpreting

Catastrophising
left the room and went downstairs Escape - Avoidance
Got a glass of water - turned on the TV Safety behaviour
Thought that if I go back to bed I will have a serious Catastrophising
panic attack and will not be able to cope
Paced up and down rubbing my arms to make sure the Safety behaviour
circulation was ok

Sleep with the light on now and make sure I have Safety behaviour
water beside me Anticipatory Anxiety
17
PA N I C S E Q U E N C E P R O F I L E TYPE OF REACTION
if. Catastrophising
Avoidance / Escape
Safety Behaviour
Physical Symptom

18
CHALLENGE IT & CHANGE IT

Challenge and Restructure the unhelpful thoughts
Below are some ideas to help you CHALLENGE inaccurate thoughts so that
you can CHANGE them to more accurate, rational responses.
CHALLENGE IT CHANGE IT
Is there any evidence that shows This is a very common symptom of anxiety -
that this thought isn’t accurate? I am having a panic attack and panic attacks
are scary but harmless.
Has this happened before - What I have felt this SO many times but the thing
was the outcome? I feared would happen has NEVER actually
happened.
Am I 100% certain that what I Going by past experience and the fact that this
fear will happen WILL happen? is a very common symptom of anxiety I can-
not really be certain anything bad will happen
Is there a clinical explanation for This is part of the Fight or Flight response - it
this symptom? is simply due to the effects of a surge of
adrenaline - I am in no actual danger.
Did the symptom increase as I got When I felt scared it felt like the symptom got
more anxious? why might that be worse. My fear caused a rush of adrenaline
and what might that show? which made the symptom increase
19
Correcting
Common Misinterpretations
Let’s have a look at some of the most common misinterpretations
that people with panic disorder make and RESTRUCTURE each
one based on the actual EVIDENCE.
EVERY person with panic disorder makes one or more of these

misinterpretations and the feared catastrophe NEVER happens.
20
Correcting common Misinterpretations

FALSE ALARM 1. “I’m having a heart attack!”
SYMPTOM - Rapid heart beats, fluttering, feeling of missed beats
ACTUAL REALITY - Panic attacks DON’T cause heart attacks!
• Rapid or ‘fluttering’ heart beat and a feeling of ‘missed’ or

‘extra’ beats are the most common panic symptoms.
• Panic releases ‘friendly’ adrenaline which causes the heart

to beat faster to prepare your body for action.
• Your heart is an incredibly strong muscle that can beat rapidly and
continuously for a long period of time without causing any damage
• People who have actual heart attacks have something wrong with their
hearts in the first place
There is a big difference between what happens with your heart during
panic and what happens during an actual heart attack.
During a real heart attack the most common symptom is continuous pain
and a intense crushing feeling in the chest. With panic the main concern is
the rapid heart beat.
• Remember - this is the most common symptom of panic and it is a FACT

that rapid heart beat with a panic attack has nothing to do with having a
heart attack.
21

FALSE ALARM 2. “I’m going to pass out / faint!”
SYMPTOM - Light headed / Dizzy / Floaty
ACTUAL REALITY - You will NOT faint because of a panic attack.
• During a panic attack you heart rate increases which leads

to a temporary and harmless increase in blood pressure.
• Fainting is actually caused by a DROP in blood pressure

so when you are anxious you are less likely to faint than
at any other time.
• We IMAGINE we may faint during panic because we feel light headed and
dizzy - this can happen because we breath more rapidly which slightly
reduces the blood flow to the head.
• Remember - your fight or flight responses have been activated so your

body is set for ACTION - not ‘collapse’
22

FALSE ALARM 3. “I’m going to stop breathing!”
SYMPTOM - Tight chest / Difficulty breathing / Choking feeling /
Sensation of ‘lump in throat’
ACTUAL REALITY - You CANNOT stop breathing because

of a panic attack.
• No one has EVER stopped breathing because of a

panic attack - it is actually IMPOSSIBLE.
• During panic you feel tension in the neck and chest

muscles which gives you the FEELING that you may
stop breathing or ‘suffocate’.
• When people panic they also tense their stomach very tightly which
causes them to have to take very shallow breaths or else they try to take
very deep breaths which can make them feel dizzy.
• If you simply LET GO of your stomach muscles you will feel air being
drawn in all by itself and your breathing will return to normal.
• Your body will automatically FORCE you to to breathe if you aren’t getting
enough oxygen - test this by holding your breath for a few minutes and see
what happens.
• You are NEVER in any danger of not breathing during a panic attack.
23

FALSE ALARM 4. “I’m going crazy - having a nervous breakdown!”
SYMPTOM - Feelings of unreality / Racing mind / Sense of
impending doom / Frightening thoughts
ACTUAL REALITY - No one has EVER gone ‘crazy’

because of panic.
People who are ‘crazy’ don’t wonder if they are ‘going

crazy’ or not. The fact that you are sanely questioning
if are going crazy is proof that you aren’t!
You are EXPERIENCING very frightening sensations.

Fight or Flight is causing your mind to be very agitated
and on the lookout for danger. There seems to be no
reason for this so you mistakenly but understandably
wonder if you are maybe going ‘mad’ or ‘crazy’.
In the midst of this overwhelming and seemingly chaotic experience there is

always a part of you that is able to watch it all happening. A part of you that
wonders what on earth is going on - that doesn’t like what is happening - that
just wants it to stop.
If you shift your focus from the EXPERIENCE to the EXPERIENCER (the part
of you that is fearfully watching it all unfold) you will realise that YOU are OK
underneath it all - it is the ‘experience’ that is frightening - that is all.
24

FALSE ALARM 5. “I’m having a stroke!”
SYMPTOM - Rapid heart beats, fluttering, feeling of missed beats,
numbness, twitching and tingling in limbs, etc
ACTUAL REALITY - Panic attacks have

NOTHING whatsoever do to with having a stroke.
• With a panic attack we can experience rapid

heart beat and strange sensations such as
numbness, twitching and tingling in our arms and
face - even right down one side of our body.
• Understandably, we MISINTERPRET these

sensations to be symptoms of having a ‘stroke’. The fact is - these symptoms
are due to the fight or flight response increasing the heart rate and draining
blood away from the skin towards the more vital muscle groups and organs.
• If you keep a regular panic attack diary you will see that you may experience
these sensations again and again yet NOTHING ever happens except feeling
a lot of fear.
• Panic attacks have NOTHING whatsoever do to with having a stroke. If you

still aren’t convinced ask your doctor.
25

FALSE ALARM 6. “I’m going to lose control!”
SYMPTOM - Sense of dread, building tension, feeling ‘unreal’
ACTUAL REALITY - Panic CANNOT make you lose control.
In panic, fight or flight symptoms are preparing you for

action.. so your mind becomes very alert and agitated.
You may FEEL that you might lose control but in actual
fact your subconscious mind is keeping you remarkably
focussed.
Think how wonderfully your mind focuses on the

symptoms. How you plan your escape with meticulous
fight or flight fuelled precision. James Bond couldn’t be so focussed!
The reason we fear we might lose control is that as we feel the symptoms
increasing we picture them ‘spilling over’ until we are running around
screaming and shouting. This is pure CATASTROPHISATION.
With panic - we may at worst appear very anxious or flustered and have to
leave a situation - but we NEVER really ‘lose control’. It just FEELS like we will.
26

FALSE ALARM 7. “my vision is blurred.. I’m going blind!”
SYMPTOM - blurred vision, strained eyes, distortion in vision
ACTUAL REALITY - Panic CANNOT make you go blind
The Fight or Flight response has been activated

because our body is mistakenly receiving signals that
we are in danger.
Fight or flight affects our eyesight in several ways. Our

peripheral vision is diminished so that our sight is
centrally focussed (on any danger) and the pupils of
our eyes widen to let in more light.
The resulting sensations make us feel that something is wrong with our eyes
but it is just fight or flight sensations and nothing else.
27

FALSE ALARM 8. “I’m going to be humiliated!”
SYMPTOM - Feeling others will be horrified at witnessing your anxiety
ACTUAL REALITY - With panic you feel much worse in your own
mind, other people may not even notice.
When people fear ‘humiliation’ they feel they will

behave in such an extreme way that others around them
will think so badly of them that they will never be able
to live with the shame and embarrassment.
If YOU saw an anxious person - even if they were VERY

anxious and had to ask for some help or leave in a hurry
would YOU think THAT ‘badly’ of them.
Keep it in perspective - the worst that will happen is that people may feel
concern for you or maybe see that you are very anxious - hardly a crime.
Even if you did throw your arms in the air and ran around shouting that the
world is filled with monsters.. in a few weeks time you KNOW you’d be
laughing about it - or at least worrying about something ELSE!
The reality is - people with panic are mostly very adept at hiding the fact that
they feel the world is just about to cave in on them.
No one probably even notices - and if they do - SO WHAT!

28

FALSE ALARM 9. “I’m going to collapse - I feel so weak!”
SYMPTOM - Shaking, trembling, ‘jelly legs’,
muscle tension, stiffness even severe pain
ACTUAL REALITY - No one has ever REALLY ‘collapsed’ due to

panic - they may dive for a chair or bed but never collapse!
When the fight or flight response is triggered it causes

our muscles to become tense preparing us for action.
If we were actually in danger we would quickly USE

this tension to fight or flee. However, in the absence of
any apparent danger we become more and more afraid
of the feeling until it feels like it will ‘weaken’ us to the
point of collapse. We may even experience intense
pain.
The fact is, no one ever really DOES ‘collapse’ with

panic. Not one single person has ever fallen down in a heap as a direct result
of a panic attack.
Consider the fact that you often feel like you can’t go FURTHER on a journey
but when you decide to return to a ‘safe’ place you can generally get there
with some considerable speed!
29

FALSE ALARM 10. Waking up in panic (Nocturnal panic attacks)
60% of people with panic disorder experience
attacks in their sleep. Many people are even afraid
to go to sleep at night..
One reason has to do with the physical changes

of ‘letting go’ that occur as we go into deep sleep.
To someone who is already on ‘high alert’ (in fear

of panic attacks) these bodily sensations can first of all wake them up and then
trigger a panic attack. The feared consequences of the sensations seem even
worse at night or when we are jolted out of sleep.
Because we were ‘simply sleeping’ we imagine that there can be no other

possible explanation for these feelings except serious illness or impending
death! Our extreme reaction can then quickly set off our fear response with a
rapid increase in the sensations.
Keep in mind that this is a VERY common occurrence and again can not cause
you any actual harm.
Practice your skills as quickly as you can to reduce misinterpretation - keep a

Flashcard by your bed. If you need to, get up and walk around until you feel the
intensity come down. Fill in a Panic Attack Diary to help you objectify the
experience. ‘Ground’ yourself by being mindful of your environment and as usual
- LET IT HAPPEN..
30

FALSE ALARM 11.
‘Derealisation’
A feeling that the world around you is unreal and
unfamiliar
‘Depersonalisation’
A feeling that your own sense of self is unreal
in comparison to ‘reality’ outside yourself
These are perhaps the scariest symptoms of panic. It’s bad enough that you feel
that your health or sanity is under threat - but when you start to wonder about the
truth of your very existence that can be VERY scary indeed.
The feeling is so bizarre you really begin to question your sanity and wonder if you
will EVER return to ‘normality’
It is extremely hard for other people to understand this feeling which increases the
sense of alienation. Try describing THIS to someone.. not easy..
ACTUAL REALITY - This feeling is simply a temporary sensory

‘overload’ caused by the escalating cycle of fear
This is a VERY common experience with panic. When people are in ACTUAL
danger they often report that it ‘didn’t feel real’ - we accept this because we can
attach it to a cause - but without a cause we feel we are losing our ‘grip on reality’.
Treat this feeling like any other symptom of panic and apply the skills you learn in
this book particularly the Mindfulness exercises. You will soon lose this fear. 31

FALSE ALARM 10. ‘Obsessional Thoughts’
Panic attacks generally involve fear of the consequences of the frightening
bodily sensations produced by the Fight or Flight Response.
However because our

mind is also set on
‘high alert’ and on the
look out for danger we
can find ourselves
repeatedly obsessing
about particular fears
or even catastrophising
about EVERYTHING.
It is helpful to observe
that this TOO is a
form of panic and not
simply the ‘absolute
truth’ about your life
experience.
Claire Weekes in her book “Self Help For Your Nerves” describes these
thoughts as “Tired thoughts in a tired mind” - this is a wonderfully simple
description.
32
OBSESSIONAL THOUGHTS
PANIC CYCLE
DISORDER
FIGHT OR FLIGHT
RESPONSE SYMPTOM MISINTERPRETING
Mind on ‘High Alert’ looking & CATASTROPHISING
for danger - sense of dread, Worry that you are going insane
can’t concentrate - agitation Worry that your life is falling apart
can’t relax, worried, Worry that you will never stop
mind ‘racing’ the thoughts
MENTAL PANIC
Overwhelming feeling of DESPERATE ATTEMPT
panic ABOUT the thoughts. TO BLOCK THE THOUGHTS
Increase in Adrenaline This increases our focus ON the
thoughts which causes more
thoughts to arise
EVERYONE who is in a state of anxiety encounters this problem to some

degree. If you find yourself suddenly overwhelmed with obsessional or
catastrophic thinking remember to CATCH IT - CHECK IT - CHANGE IT
Say to yourself - “Right, catch it, I’m having a mental panic attack, I’m
Catastrophising, these are just thoughts, let them be, it’s ok this happens with
panic, it’s normal, if I wait it will pass, let it do it’s worst, refocus, relax
stomach, look around, wait..”
33
Obsessional Thoughts
A useful technique - shift to OBSERVER mode.
Have you ever caught yourself inwardly screaming “I WISH THESE

THOUGHTS WOULD STOP!”
‘Who’ is it that says that?.. Clearly a part of you is NOT the thoughts. A part
of you doesn’t like or WANT the thoughts. A part of you is quite rational and
doesn’t want to be tormented BY these thoughts. It is like having an annoy-
ing song stuck in your head.
The next time you feel overwhelmed by disturbing or obsessional thoughts

shift to OBSERVER mode. Imagine stepping back and observing the thoughts
slightly in front of you or drifting by like clouds.
Totally caught up in thoughts OBSERVER MODE
HOLD your attention on your observing self and let the thoughts ‘do their
thing’. Don’t fight or resist them, don’t try to get rid of them - just let them be
- they are ultimately JUST thoughts. If you get pulled into the thoughts step
back again.
This will give you some DISTANCE from the thoughts which will stop you
from adding misinterpretation and catastrophisation.
Practice this ‘observer mode’ as you go about your day and remind yourself
that this is very common with panic. Treat it like any other symptom, let it hap-
pen, give it time, it will pass. 34
Keeping a ‘Panic Attack Diary’
When you are learning about panic and trying

to relate it to your own experience -- it is very
helpful to write down all your observations in a
Panic Attack Diary.
The Diary is useful in many ways
• It helps you monitor your experience from a more objective

point of view
• Helps to ‘NORMALISE’ your symptoms and reactions.
• You see more clearly the connection between symptoms

and catastrophic thoughts and behaviours
• You learn how to IDENTIFY, CHALLENGE and CHANGE any

unrealistic thinking.
It is MOST useful if you can fill it in DURING a panic attack.
DO THIS RIGHT AWAY - Print out several for each day of the
week.
35
PA N I C AT T A C K D I A R Y - E X A M P L E
4/04 1.30am Woke up felt numbness in arm 7 to 8

Date Time Location / Situation / Activity Severity (from 0 to 10)
SYMPTOM CHECKER
√ Sweating
√ Palpitations / Heart racing Feeling ‘unreal’
Nausea
Churning stomach
Dizziness / faint Dry mouth Diarrhoea
Choking / ‘Lump in throat’ √ Hot / cold flushes √ Feelings of numbness
Tight chest √ Trembling / shaking Tingly fingers or face
Shortness of breath Tightness across head Floating feeling
‘Wobbly’ legs Blurred vision
PANIC THOUGHTS ALTERNATIVE EXPLANATIONS
I can’t get any feeling in my It is a common symptom of anxiety

arm! Fight or Flight can cause such sensations
I felt this a few weeks ago too and nothing
came of it
I know I have worried about it since
DEEPER FEARS / BELIEFS
(why are the above thoughts
It’s just an unpleasant sensation - I can

so ‘catastrophic’)
This could be a sign of still move my arm just fine - it’s not painful
a stroke or paralysis
SAFETY BEHAVIOUR / AVOIDANCE Rubbing my arm - jumped out of bed

had to get a drink of water - phoned Jean
didn’t go back to bed
36
PA N I C AT T A C K D I A R Y
Date Time Location / Situation / Activity Severity (from 0 to 10)
MAIN SYMPTOMS
Sweating Nausea
Palpitations / Heart racing Feeling ‘unreal’ Churning stomach
Dizziness / faint Dry mouth Diarrhoea
Choking / ‘Lump in throat’ Hot / cold flushes Feelings of numbness
Tight chest Trembling / shaking Tingly fingers or face
Shortness of breath Tightness across head Floating feeling
‘Wobbly’ legs Blurred vision
PANIC THOUGHTS ALTERNATIVE EXPLANATIONS
DEEPER FEARS / BELIEFS

(why are the above thoughts
so ‘catastrophic’)
SAFETY BEHAVIOUR / AVOIDANCE
37
Examples of common Catastrophic Thoughts

(for Panic Diary)
“I’m going to have a heart attack”
“I’m going to pass out / collapse / faint”
“I’m going to make a fool of myself”
“I won’t be able to act normally / speak / walk”
‘I won’t be able to cope”
‘Maybe I have a brain tumour / MS / cancer etc”
‘I’m going to die”
‘I’m not going to make it out of here”
‘What’s happening to me”
‘I’ve got to get away from here NOW!”
“I’m going to completely lose control”
“Everyone is going to see how anxious I am”
“People will think I am crazy”
“I can’t breathe”
“There must be something seriously wrong with me”
“This is never going to stop”
After a ‘Setback” (see Workbook 4)

“I’ve done all the practice and now I’m just as bad as EVER!”
“I should be better by now - this is never going to go away”
“Maybe there is something ELSE wrong with me”
“I’m no good at this - I can’t do it”
38
Examples of common Behavioural Reactions

(for Panic Diary)
Tensing against the feelings
Taking deep breaths
Pacing up and down / rubbing hands
‘Watching the clock’
Watching every sensation
Trying to relax / having to lie or sit down
Trying to block it out with distraction
Seeking escape
Using ‘safety behaviours’ - sitting near an exit / only going

out with people we feel ‘safe’ with / avoiding heat / Trying
to think of ‘anything but the feelings’ / Getting a drink of
water etc
39
Part 2.
ACCEPTANCE
BEHAVIOUR STRATEGIES
which will help you
REDUCE safety behaviour
& Sail
TEST restructured thoughts
through panic
40
Acceptance Behaviour Strategies
RESISTANCE and AVOIDANCE MAINTAINS the problem
1. When you resist, fight, tense against, or try to change or make

panic stop through deep breathing or relaxation exercises you are
strengthening your own mistaken belief that the symptoms mean
you are in grave danger. “I’ve got to make this stop or else....”
The truth is - panic CANNOT cause you any ACTUAL harm
2. Resistance also further activates the Fight or Flight Response

which leads to more adrenaline and more frightening (though
harmless) symptoms.
ACCEPTANCE SPEEDS RECOVERY
1. When you learn to ACCEPT and FACE the symptoms you

strengthen the new understanding that panic - although frightening
- cannot do you any ACTUAL harm at all.
2. Ironically, when you ACCEPT the symptoms you DE-activate the

fight or flight response so the symptoms reduce.
3. ACCEPTANCE enables you to go THROUGH panic so that you can

TEST your new information and restructure the misinterpretations.
41

CATCH IT - Notice the resistance, avoidance and safety behaviour
CHECK IT - Remember it’s a FALSE ALARM - you are in no danger
CHANGE IT - Move from resistance to ACCEPTANCE
Catch it Check it Change it
STOP trying to STOP panicking! - LET PANIC HAPPEN

You feed the cycle by trying ‘desperately’ NOT to panic. Panic cannot do
you any actual harm. When you let panic HAPPEN - it dies down!
Don’t tense AGAINST the panic - ‘Let go’ TOWARDS the feelings
Tensing AGAINST the feelings creates MORE adrenaline! Imagine moving
forward to ‘greet’ the panic rather than ‘fight’ it. Panic cannot do you any
actual harm.
42
Don’t ‘TRY’ to RELAX! - just LET GO of any added tension

Apart from the fact that trying to relax actually makes you more tense (like
trying to go to sleep) - you don’t NEED to relax - You are in no danger.
Since you probably WILL ‘try’ to relax, just LET GO

of any added tension. Imagine you held a sponge
scrunched up tight in your hand and you just ‘let go’
of it - it would simply return to its most relaxed state
- without TRYING.
Or imagine you are Pinocchio with his ‘strings cut’

- just go floppy - go ‘limp’.
You don’t need to do deep breathing - Just relax your stomach

When someone feels anxious they automatically tense their stomach
muscles. Then they either take very shallow breaths which can lead to a
feeling of dizziness or they use ‘deep breathing’ to
try and ‘calm down’. This can then become a ‘safety
behaviour’ which feeds the fear cycle.
If you simply LET GO of any tension in your stomach

you will see that your breathing is just fine. Notice
the stomach gently rise and fall with each breath.
43

Why deep breathing exercises can make things worse!
Imagine you are feeling panic - and you think..ok I’ve GOT to do deep breathing! in - out - in
out - one, two, three, four!! You can see that at a deep level your whole effort in doing the
breathing is to desperately STOP the panic.
And even if you DO stop the panic - Does that mean you have lost your fear? Maybe
temporarily but deep down the fear is completely intact. You would still believe that if you
hadn’t done the deep breathing - WHO KNOWS WHAT MIGHT HAVE HAPPENED!!
You may then think that since you can’t do deep breathing if you are outside or at work or in
a shop you better avoid those places and stick to places where you CAN do the breathing.
You can see that this doesn’t really deal with the FEAR of panic - it just prolongs it.
Now - let’s look at an alternative approach. Imagine again that you are feeling panic -
you are overwhelmed by fear - you feel you can’t get a breath..
Ok - first notice that you probably have tightened up - fight or flight is increasing.
Notice that and let go your stomach muscles - your breath will flow normally all by itself
Ground yourself - feel your feet on the floor - instead of focussing all your attention on the
feelings - pull back - take in your environment - let go all over.
Can you see how this is different? Rather than trying to stop the panic at all costs you have
met it half way. You stopped ADDING to the cycle of fear. There is a big difference in taking
a good deep breath because you realise you are holding your breath or your breathing is
shallow and ‘practicing’ deep breathing in a frantic attempt to STOP panic.
44

Panic can come in waves -
RIDE the waves.. FLOAT through them.
Sometimes you may feel ‘waves’ of panic.
This is perfectly normal and due to the
surges of friendly adrenaline. Remember
that you are never in any actual danger.
When a wave arises just ‘float’ WITH it -
it will pass.
Stop ZOOMING in on the symptoms - Focus outward

During panic we focus so intently on the sensations we ‘lose touch’
with our immediate environment which can cause us to feel ‘unreal’.
Reconnect with your surroundings. Feel your feet on the floor - listen
to sounds - look around the reality is you are in NO danger.
Let the anxiety continue in the background - you don’t NEED to focus
on those sensations - they can’t do you any actual harm.
45
Stop ‘Stirring the pond’ -

just LET IT BE - DO NOTHING
Imagine stirring a pond with a long
stick. The more you stir the more
everything gets churned up. What
would be the quickest way that the
pond could return to normal? -
That's right.. STOP STIRRING!
It’s what you STOP doing that’s important. It is your stirring that is
causing the churning and remember, even after you stop stirring, it will
take TIME for the pond to settle.
It’s the same with panic - Every time you tense up, ‘think the worst’, or
even try too hard to relax you ‘stir’ the Fight or Flight response. You are
never in ANY danger even if you DO stir it up but the increase in
adrenaline will simply create more symptoms.
Next time panic arises - remember it is just a rush of adrenaline that has
become stirred up. Then LEAVE IT ALONE and STOP STIRRING. Let it
settle down. Imagine it swirling slower and slower. Remember it has a
certain amount of motion that will take TIME to slow down.
46

Stop looking so SERIOUS!
- SMILE !
I know it seems like a strange
suggestion but ‘smiling’ can
help remind you that ‘all is
well’ - so no need for any more
Captain
fight or flight responses!
ADRENALINE
Stop watching the CLOCK! - It will pass - WAIT - give it TIME.

Adrenaline cannot be produced indefinitely - this WILL pass - and each
time you let it pass you prove to yourself that panic - although scary - is not
actually dangerous.
Even try going to the other extreme - say to yourself - “Ok - if it takes all day
- so what - it’s just adrenaline - I’m in no danger” This helps diffuse the sense
of ‘urgency’.
47

Distract yourself if you feel you need to but
FACE the feelings at the same time.
If you need to - distract yourself - that’s OK - this is NOT an endurance test.
But AS you distract yourself don’t block out the feelings. Let them exist - they
are just fight or flight symptoms -
You are in no actual danger.
Ultimate Acceptance # 1.
IGNORE the panic -
get on with your day - you can do it..
Facing and accepting the symptoms
doesn’t mean you have to sit motionless
with gritted teeth until you feel no more panic.
To truly face and ‘accept’ the feelings would mean to almost IGNORE them -
and get on with your day. After all, you are not in any actual danger.
When panic arises practice for a while but then carry on with life - either at
work or at home - watch TV - clean the house - call a friend - do some
gardening - but AS you do these things PRACTICE letting the panic happen -
in the background - with the attitude of - “go ahead - do your worst - it’s only
adrenaline”
48

Ultimate Acceptance # 2. - Try the following ‘Experiment’
Deliberately EXAGGERATE the symptoms and see what happens!
Yes - you heard me! Since you are in no danger whatsoever - prove this to
yourself by ALLOWING the symptoms to be as bad as they will be.
Deliberately exaggerate the

symptoms and see what
happens. If you are shaking..
shake even MORE. If you are
tense.. tense UP even more.
If you feel faint.. imagine
ALLOWING yourself to faint.
You will make the amazing

discovery that once you
accept to this degree you lose
your fear and the symptoms
die down..
This is a powerful technique -

don’t dismiss it because it
sounds too scary.
49

After a panic attack there is NO NEED to be ‘careful’ with yourself! -
Get on with your NORMAL routine
When panic dies down we become overly ‘careful’ with ourselves in case we
‘set it off again’. This increases Anticipatory Anxiety. Adopt the attitude - “so
what, if it happens again, I’ll deal with it, I’m in no danger, it’s just adrenaline”
Between panic attacks - apply these skills to any ‘Anticipatory Anxiety’

Observe any fearful anticipation / Face and Accept it / LET it happen - don’t
‘try’ to relax or ‘stop it’ or ‘get rid of it’ / LET GO TOWARDS IT ALL.
50

summary..
CATCH IT - CHECK IT - CHANGE IT
Avoidance maintains panic - ACCEPTANCE speeds recovery
Don’t tense AGAINST the panic - ‘Let go’ TOWARDS the feelings
STOP trying to STOP panicking! - LET PANIC HAPPEN
Don’t ‘TRY’ to RELAX! - just LET GO of any added tension
You don’t need to do deep breathing - Just relax your stomach
Stop ‘Stirring the pond’ - just LET IT BE - DO NOTHING
Stop ZOOMING in on the symptoms - Focus outward
Panic can come in waves - RIDE the waves.. FLOAT through them.
Stop looking so SERIOUS! - SMILE
Distract yourself if you feel you need to but face the feelings at the same time.
Ultimate Acceptance 1 - IGNORE the panic - get on with your day - why not?
Ultimate Acceptance 2 - Deliberately EXAGGERATE the symptoms!
After a panic attack there is NO NEED to be ‘careful’ with yourself! -

Get on with your NORMAL routine
51
Part 3.
Mindfulness Techniques
Learn to OBSERVE
rather than ‘react’ to the panic
Mindfulness is the practice of being fully aware of

the entirety of your present moment experience - in a
NON JUDGMENTAL
way (and you don’t try
to change anything in
any way).
You may think that

during a panic attack
you are TOO aware of
what is happening but
during panic we tend to focus ONLY on the sensations
and blank everything else out. This then EXAGGERATES
the sensations!
52
Lessening your focus on the panic
1. Be mindful of your surroundings

Refocus your attention
When panic arises we tend to focus ALL our

attention on the sensations and blank everything
else out. This then EXAGGERATES the sensations!
Remember the ‘bigger picture’. Take in your

surroundings - look around you - notice objects,
people, colours, sounds, smells, - feel yourself IN your body - IN
your surroundings. Normalise your breathing - let go - stop giving
the sensations your undivided attention.
The panic is only a tiny part of a very stable ‘bigger picture’

Remind yourself that there is no actual danger in a room, a shop, a
meeting or wherever. Use the outer stability to help stabilise your
reactions. Don’t block out
the sensations just see
them as part of a ‘bigger
picture’.
And remember - even the

horrible sensations are
not ‘really’ harmful.
53
Learn to OBSERVE rather than ‘react’ to the panic
2. See the thoughts as JUST thoughts..
We tend to identify COMPLETELY with our thoughts - we imagine that what-

ever we think must be how life actually IS - but it is possible to ‘step back’
and OBSERVE thoughts as they arise.
This then gives you a sense of being separate FROM your thoughts. When
you see thoughts as JUST thoughts you then feel more able to choose how
you want to REACT to them.
FOR EXAMPLE
THOUGHTS ARISE - “Oh no, I feel so dizzy, what is wrong with me, what if
I pass out, why is this happening to me, I am never going to get better”
MINDFULNESS - (first you may need to ‘think’ about being ‘mindful’)

“ok, hold on - step back - observe - these are THOUGHTS - they are
gathering a life of their own and I am getting caught up in them”
Then simply OBSERVE - try not to judge

the thoughts as good or bad just see the
thoughts coming and going as if they were
clouds drifting by.
When you stop giving the thoughts more

energy they die down.
54
3. See sensations as JUST sensations..
When we focus on sensations we often misinterpret and catastrophise.

However, if we try to block out the sensations we still have the fear of them
in the ‘back of our mind’.
Mindfulness enables us to experience the sensations without adding further

(mis) interpretation and this helps to desensitise us TO the sensation because
we see that nothing else is happening.
EXAMPLE
SENSATION - Tingling in fingers / arm - we either
worriedly focus our attention on the tingling
which intensifies it - or we try to block it out by
focussing elsewhere - but the fear remains.
MINDFULNESS - We allow ourself to experience

the tingling as PART of our overall experience -
we try not to judge it as good or bad but just
OBSERVE it as simply (unpleasant but harmless)
sensation thus reducing the fear.
55
4. Test Pilot mode

It can help reduce Misinterpretation and Catastrophisation if you describe (to
yourself) how you feel as if you were an outside impartial OBSERVER.
Imagine you were a TEST PILOT reporting your feelings and

experience to ‘ground control’.
Do it in a ‘factual’ rather than ‘emotional’ way. So for example instead of

worriedly saying “These thoughts are scary...what is wrong with me... will I
NEVER get better ..am I going insane etc etc”
DESCRIBE the feelings without further ‘interpretation’
COME IN GROUND CONTROL..

ie. “These thoughts are scary”, AM EXPERIENCING SOME DIZZINESS..
“I feel a tightness in my stomach” LEGS QUITE WOBBLY..
HEART RATE INCREASING..
MAY GO INTO A DIVE AT ANY MINUTE..
“I feel VERY uneasy - it is coming
in waves.. etc etc” OVER
This will help you feel more in

charge of the situation. It also
means you aren’t trying to block
the feelings but nor are you
‘catastrophising’ them.
56
5. Thought ‘labelling’
Instead of getting involved in the ‘details’ of a train of thought - give it an
overall ‘label’ - for instance - “I'm CATASTROPHISING again - that won’t
help..” - this stops the train long enough for you to GET OFF so that you can
think in a more rational way.
57
6. Question and Answer

To further increase the sense of being a detached OBSERVER try asking
yourself the same type of questions a skilled therapist might ask.
QUESTION Possible ANSWER
“Has this happened before and what “Yes - I have felt this many times but
was the outcome? what I feared would happen never
actually happened”
“What might that suggest?” “This is just anxiety - just exaggerat-

ed fight or flight symptoms”
“Now that you know about panic, is “This is just anxiety - I am in no real
it true that you are in real danger?” danger - it just feels terrifying”
“Are you trying to NOT panic at all “Yes, I know I am desperately

costs or resist the sensations?” hoping I won’t panic”
“Are you ‘checking in’ on the “Yes - I should just let them be -
sensations to see if they have ‘gone after all I am in no danger..”
yet’?”
58
So how on earth
are you going to
REMEMBER all this
if you panic?!
‘NORMALISING’
STATEMENTS
&
‘FLASHCARDS’
59
NORMALISING Statements
When you feel your anxiety rising or you are in the middle of a
panic attack it is VERY difficult to ‘think straight’.
Normalising statements are short ‘bullet point’ reminders of

everything you have learned about panic.
So, for instance, instead of having to go over everything about

fight or flight and how adrenaline is released and how our
misinterpretation leads to increased adrenaline and so on..
This can all be brought to mind instantly by the STATEMENT..
“It’s JUST Adrenaline..”
I have given some examples of normalising statements in the

following pages but it is a good idea to make up your own. Try
to target specific fears or use statements that you feel help
the most.
Then either memorise them or write them out on a

FLASHCARD. Once you use them a few times you will be
able to recite them by heart.
Also, when you say the statements - either out loud or into
yourself - try to say them calmly as if you were talking to
your whole body and mind.
60
BEFORE OR AFTER FEELING PANIC
“It’s ok - if panic happens it is just anxiety - just adrenaline..”
“No matter how many times I feel this I am NEVER in any ACTUAL
danger - it just feels horrible”
“If I panic it will be a chance to practice recovery..”
“I will use my new skills - I will get through it ok”
“I don’t have to be ‘careful’ with myself”
“I can just get on with whatever I need to do - if I panic I panic..”
“It’s just anxiety - just fight or flight sensations”
“These feelings can happen out of the blue - it’s very common”
“Just because I feel these sensations doesn’t mean I will always panic”
“No need to focus on every sensation - it’s anxiety - just adrenaline just
let it be - no need to catastrophise - I am in no danger”
“The feelings always pass”
“Panic is a horrible experience but nothing serious has ever actually

happened - it is just anxiety..”
61
DURING PANIC
“These are just anxiety symptoms. - It’s just ADRENALINE”

These are normal feelings of anxiety in an exaggerated form.
This can happen ‘out of the blue’ for no clear reason.
“I am in no danger at all”
I am NOT in any actual danger either physically or mentally
“My body is trying to HELP me - it’s just a mistake”

My body thinks I am in danger and is trying to help with the fight or flight
response..
“Everything is ok.. (Let go - smile) there’s no danger”
“Stop stirring - why add more fear - let it settle”

I am causing more adrenaline by adding fear - let it be - let it happen
“Let go towards it - even just a bit”
“It takes TIME for it to settle down
“This WILL PASS - adrenaline cannot be produced forever”

The body can never remain at an intense level of panic indefinitely - it
MUST always die down. Adrenaline has a LIMIT.
“It’s just the Panic Cycle - nothing else - no big deal”
62
DURING PANIC continued..
“Go ahead.. do your worst..”

Its just sensations - it just FEELS scary That's all.
“It’s my OWN fear that keeps this going - nothing else”

There is nothing happening ‘to me’
“It’s normal to feel afraid - these sensations are very uncomfortable”

Of COURSE it is understandable - who WOULDN’T be afraid!
“Here it comes again - that’s ok - it comes in waves”

Float with the feelings - ride the waves
“I have felt this many times now and nothing happened except I felt
terrified - it will be the same now - nothing dangerous is going to
happen - it is just anxiety
“This is a GREAT OPPORTUNITY to put my new understanding to

the test - the more I do that the less I will fear panic and when I lose
my fear of panic it will STOP happening”
“Even if I panic all day I am still in no danger - It is still just adrenaline -

It will pass eventually.
63
‘FLASHCARDS’
It’s hard to think rationally in the

middle of an attack so it can be
helpful if you have all the key points
for practice written down on a piece
of paper to help remind you. This is
called a ‘Flashcard’
I have created some flashcards for

you but you may prefer to make your
own based on coping skills and
restructured thoughts that are most
relevant to you.
Print your flashcard at whatever size you would feel comfortable

reading in public. Maybe you might want it to fit in your wallet or
handbag. You may want to get it laminated?
64
EXAMPLE FLASHCARD
WAIT even for just a few more seconds..
Let go all over - Relax stomach

Feel feet on the floor - Look around - smile
I am in no ‘actual’ danger - it’s just adrenaline

LET IT HAPPEN
IT WILL PASS - adrenaline has a limit

WAIT and give it TIME
ACCEPT the feelings - it’s just Fight or Flight

Let go TOWARDS it even slightly
Stop zooming in on the symptoms

Focus outwards - Take in the surroundings
ALLOW the feelings to continue in the background
Stop ‘STIRRING’ the Adrenaline - leave it alone - let it settle
Give it TIME to pass - it WILL pass
65
EXAMPLE FLASHCARD - ‘NORMALISING STATEMENTS’
“These are just anxiety symptoms - Fight or Flight...”
“It’s scary but I am in no danger at all”
“It’s just ADRENALINE”
“Everything is ok.. (let go - smile) there’s no danger”
“Stop stirring - do nothing - let it settle”
“Let go towards it - it will pass”
“It takes TIME for it to settle down
“If I WAIT - IT WILL PASS - adrenaline cannot be produced forever”
“Go ahead.. do your worst..”
66
FACING the panic will help me lose my fear of panic
“These are just anxiety symptoms - Fight or Flight...”
“It’s scary but I am in no danger at all”
Let go all over - Relax stomach
Feel feet on the floor - Look around - smile “It’s just ADRENALINE”

I am in no ‘actual’ danger - it’s just adrenaline
LET IT HAPPEN “Everything is ok.. (let go - smile) there’s no danger”
IT WILL PASS - adrenaline has a limit “Stop stirring - do nothing - let it settle”
WAIT and give it TIME

“Let go towards it - it will pass”
ACCEPT the feelings - it’s just Fight or Flight “It takes TIME for it to settle down
Let go TOWARDS it even slightly

“If I WAIT - IT WILL PASS - adrenaline cannot be produced forever”
Stop zooming in on the symptoms

Focus outwards - Take in the surroundings
ALLOW the feelings to continue in the background “Go ahead.. do your worst..”
FLASHCARD - PRINT AND FOLD

Stop ‘STIRRING’ the Adrenaline - leave it alone - let it settle

GIVE IT TIME TO PASS - it WILL pass
67
Visual Flashcard
IT’S A FALSE ALARM

RELAX LET GO ALL OVER
FIGHT OR FLIGHT
STOMACH FEEL FEET ON FLOOR
JUST ADRENALINE
TRYING TO STOP IT LET GO TOWARDS IT

INCREASES ADRENALINE YOU ARE IN NO DANGER FOCUS OUTWARDS
IT’S JUST UNPLEASANT

BUT HARMLESS LET IT HAPPEN ADRENALINE HAS A TIME LIMIT
SENSATIONS YOU ARE IN NO DANGER IT WILL PASS - GIVE IT TIME
68
How practicing your skills

on panic attacks develops
Like learning any new skill - the more you PRACTICE the easier it
gets but be prepared that it TAKES TIME. To begin with it feels like
a struggle to remember anything you have learned and your mind
feels torn between catastrophising and practicing
Let’s look at how practice develops over time..
1. Prior to knowing the truth about panic attacks
FEELINGS ARISE
AUTOMATIC REACTION - (we tense every muscle in our body)...
THOUGHTS - “Oh no here it comes..this feels like a REALLY bad

one...what am I going to do ...got to get away...get out of here..what if I
can’t get through this...Oh my god this is horrible..I can’t go on like
this...why has this happened to ME ??!! etc, etc, etc, etc, etc, etc,”
69
How practice develops

2. After putting in some practice
FEELINGS ARISE
REACTION - Oh no ..here it comes (we tense up)
PRACTICE - “Hold on - catch it, stop fighting - it’s just adrenaline
REACTION - This one feels really bad...maybe I can’t get through this
one..
PRACTICE - There I go again...catch it .. ACCEPT - LET IT HAPPEN
relax TOWARDS the feelings even slightly
REACTION - I STILL feel awful ...this isn’t working ...I’m HOPELESS at
this ...I’ll NEVER be able to do this ...
PRACTICE - I HAVE to TRY...I was told I might feel like this ...this is
how it happens with everyone ...the PRACTICE will take time to work ..
Fighting it or running away is what is keeping it all going ...there is
nothing out to get me ..I’m just adding fear and getting caught up in
the anxiety cycle...if I choose to experience the feelings even slightly I
won’t have as much fear...
REACTION - I really HATE THIS !!!
PRACTICE - Stop stirring ..it will pass...got to PRACTICE.. have to
CHOOSE now this minute to PRACTICE
REACTION - this has gone on SO long ...what will become of me?
PRACTICE - STOP - THIS MOMENT is all that matters HERE...NOW.. I
can choose to PRACTICE with this NOW.
It is just anxiety / adrenaline - it WILL pass if I wait..

70
How practice develops

3. After a LOT of practice
FEELINGS ARISE
REACTION - Oh oh.. Here come the feelings
PRACTICE - Okay ...stop fighting ...let go all over like a sponge ...
Let the feelings happen ...relax TOWARDS them ...let go...it will pass
...it will be okay ..I am in no real danger ...it is just adrenaline...stop
stirring it up...it will pass ...
REACTION - (sensations with a bit of fear)
PRACTICE - Let go ...let them BE...you have got through this many
times before...this TOO will pass
REACTION - FEELINGS SUBSIDE - Get on with your day....rehearse the

truth...PRACTICE on mild anxiety...do awareness exercises
...read..study....play.......
71
Remember.. even if you don’t do

ANY of this practice.. you are still OK!
These skills are intended to help you face panic so that you will see
that the fight or flight sensations are not dangerous. This will
eventually lead to less and less panic.
But keep in mind that ultimately - whether you do these exercises or

not panic can NOT do you any actual harm. It can be a terrifying
experience, but you are NEVER in any real danger.
So if you find it hard to remember the coping skills at least keep one
thing in mind... NO MATTER WHAT - PANIC IS NOT HARMFUL
NOT
HARMFUL..
NOT HARMFUL..
NOT HARMFUL..
NOT
HARMFUL..
NOT HARMFUL.. NOT HARMFUL.. 72
The reason we avoid too many ‘details’
You may wonder when you read through these workbooks why we don’t go into more details
about the various anxiety symptoms. There is a VERY good reason for this. It is the amount
of IMPORTANCE that you attach to a symptom that increases it.
While it IS important to explain that a particular symptom is actually harmless it is EQUALLY

important to drop your focus on it.
I read posts on anxiety forums and people go into such DETAILS about symptoms - even
when they are trying to help. - but the focus is on the symptom and the technical medical
terminology and so on - NOT on letting GO of the FOCUS on the symptom - which is
actually the ONLY problem.
I too remember wanting a NAME for what I was feeling - I thought that would make me feel
better - but the truth is we are caught in a cycle - we don’t ‘have’ anything - we THINK we
‘have’ something and that’s the problem - that thought increases our anxiety which increases
the symptom.
The IMPORTANT part is stepping BACK - moving on - letting it be - allowing it to exist -

because, with panic disorder, the symptom is merely exaggerated bodily sensations that can’t
do you any actual harm.
Look at it this way - people who have overcome panic through exposure and acceptance
strategies no longer give a HOOT about the details of physical or mental sensations.
It is ANXIETY that makes you want to know more - it is a form of reassurance seeking.
We imagine that if we find out more technical details about symptoms it will help us get rid
of them. But it actually works against us.
I know you won’t believe this but you would RAPIDLY accelerate your recovery if you
NEVER again bothered about the intricate details of any symptom and instead concentrate
on GETTING USED TO symptoms as simply being harmless (albeit alarming) sensations.
It takes courage to begin with to stop trying to ‘figure it all out’ and find answers. You think if
you do that something bad might then happen. It won’t. We all think that. Think of how many
times you really believed you were seriously ill 73
Summary of Step 2 - Rapid Recovery Skills
• These skills are designed to help you FACE panic not AVOID it!
• Change the way you THINK - correcting catastrophic thinking

significantly reduces the fear of panic
• When you are no longer AFRAID of panic it will STOP

happening
• CATCH IT - CHALLENGE IT - CHANGE IT - TEST IT
• Identify distorted thoughts using a Panic Sequence Profile
• Keep a Panic Attack Diary
• Change your BEHAVIOURAL REACTIONS

Reduce Safety Behaviour / Test thoughts / SAIL through panic
• FACE and ACCEPT the feelings - LET PANIC HAPPEN
• ‘Mindfulness Techniques’ - Learn to OBSERVE rather than

REACT to the panic
• Use ‘Normalising Statements’ and FLASHCARDS
• How practice DEVELOPS
• REMEMBER - NO MATTER WHAT - YOU ARE OK..
74
You are now ready for
Workbook 3

Ansiedade Recuperação

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© COPYRIGHT NOTICE

Caroline Stewart & Robin Hall

© 2010 Caroline Stewart & Robin Hall

ALL RIGHTS RESERVED.

Any unauthorised reprint or use of this material is prohibited.

No part of this book may be reproduced or transmitted in any form

When you lose your fear of panic

To lose your fear you have to PROVE to yourself that

To DO that you have to eventually be able to

The PROBLEM The SOLUTION

Harmless but Frightening 1 KNOWLEDGE

These are NOT ‘relaxation’,

Your goal is to NOT CARE if you panic or not

When you are no longer afraid of panic attacks

These skills will help you FACE (and so reduce)

That is the ONLY way you can REALLY learn

"Supposing a tree fell down, Pooh, when we were

"Supposing it didn't," said Pooh after careful thought.

Correcting mistaken beliefs ABOUT

You need to replace your mistaken

If you bring to mind the ACTUAL

- that it is just a result of the fight or

the stronger belief in those thoughts will

There are 4 STEPS to changing the way

Miss Interpret Mr Catastrophise

Consider the following questions...

What were you thinking

BEFORE - DURING and AFTER the panic attack?

• Were you thinking any anxious thoughts prior to the panic?

What are you REALLY afraid of?..

And what do you fear most about collapsing?

QUESTIONS to help take you to the ROOT thought

I’m going to lose control My legs are so weak I won’t make it

Everyone will think I am crazy Someone will need to rescue me

They will have to call for a doctor I will be totally embarrassed

Fear of panic attack in a shop I can’t climb that many stairs

I can’t go into the shop I can’t climb that many stairs

I will have a panic attack I will become fatigued

I need to stop this feeling of unreality I won’t go to that party

The feeling will overwhelm me It may trigger a panic attack

Feeling a need to control a physical symptom Fear of driving on the motorway

I need to control my shaking hand The motorway is too scary

The assistant will see I am nervous I will have a panic attack

They will think I am weak No one will be able to help me - I

SURFACE LEVEL PANIC THOUGHTS

QUESTIONS to help take you to the ROOT thought

UNDERLYING FEARFUL THOUGHTS

Identifying thoughts using a

Pick a recent panic attack episode and break it down into a

Note the physical sensations, exact thoughts and behaviour AS

This enables you to see how your thoughts or behaviour added

Look at the example profiles on the next few pages..

Sitting in restaurant - just about to start meal

HOW THE PANIC ATTACK UNFOLDED

felt my heart fluttering Physical Symptom

thought I was going to have a heart attack or Misinterpreting

Was convinced there was something seriously wrong Misinterpreting

Worried about it all night and ever since Anticipatory Anxiety

THOUGHTS / BEHAVIOUR AFTER THE PANIC

In bed - woke up felt ‘strange’

HOW THE PANIC ATTACK UNFOLDED

as soon as I woke up my arm felt numb Physical Symptom

thought I was going to lose all feeling in it Misinterpreting