What is Worry?

Worries are unpleasant thoughts that you can’t get out of your head. They’re like
annoying bugs that keep buzzing around and won’t leave you alone.

It’s normal to have worries—everyone has them from time to time. It’s only a problem
when your worries get in the way of other parts of your life, or if they make you unhappy.
What do you worry about? Circle at least three of your worries from the lists below:

Family School Friends Other

Arguments or Fights Following Rules Fitting In Getting Hurt

Upsetting Family Grades Making Friends Being Embarrassed

Family’s Safety Presentations Being Teased Appearance

Getting in Trouble Homework What to Talk About Money

Sick Family Member Tests Bullies

When you worry, your body goes through a number of changes. These changes can be
uncomfortable, and for some people they’re scary. Circle each of the worry symptoms
that you’ve experienced:

Fast
Sweating Feeling Sick Shaking Feeling Hot
Heartbeat

The good news about worry is that it can’t hurt you. Worrying might be uncomfortable,
but you can learn to control it with a little practice. Is there anything you already do that
helps you control your worry?

To control my worry, I…

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 the vicious cycle of
The symptoms of anxiety can have a significant impact on
how a person behaves and goes about their daily life. For
example, anxious people might try to avoid feeling
anxious and escape from distressing experiences.
The essence of anxiety is worrying about some potential
threat. It is trying to cope with a future event that you
think will be negative. You do this by paying more
attention to possible signs of potential threat, and looking
internally to see whether you will be able to cope with
that threat. When you notice your anxious symptoms,
you think that you can’t cope with the situation, and
therefore become more anxious.
The Vicious Cycle of Anxiety
Anxiety
LONG TERM: Increase Increased scanning for
in the physical symptoms danger, physical symptoms
intensify, attention narrows
of anxiety, more worry,
loss of confidence about & shifts to self
coping, increased use of
safety behaviours
Escape or avoidance
SHORT TERM: Relief
How Avoidance Contributes to Anxiety
As your anxiety increases, you try to reduce the anxiety
and prevent what you think might happen by avoiding the
situation. If you cannot avoid the situation, then you use
subtle avoidance to reduce the anxiety.
For example, you may use certain rituals, like standing
close to a door to make a quick escape. In some way, you
might feel less anxious when you engage in avoidance
behaviours. You may take tranquillisers to deal with
distressing situations.
However, when you have to deal with the situation the
next time, you are less confident that you can cope with
it because you avoided it the last time or become
dependent on safety behaviours. So you feel more
anxious.
As a result, you avoid the situation or engage in subtle
avoidance. And so it continues. This cycle can go on until
you feel very anxious and avoid going into different types
of situations.
Safety Behaviours and Anxiety
If you feel anxious, or anticipate feeling anxious, it makes
sense that you will do things to reduce your anxiety. In
addition to avoidance and subtle avoidance, many people
use “safety behaviours” to help cope with anxiety. These
may include relying on medication, always having an exit
plan for potentially-anxious situations, or making sure you
have someone else with you. These safety behaviours
also play a part in the vicious cycle of anxiety. When you
become dependent on them, it can be more distressing if This document is for information purposes only. Please refer to
one day they are not available to you.
anxiety
Reversing the Vicious Cycle of Anxiety
Vicious cycles play an important role in maintaining anxiety.
However, like the vicious cycle of depression, you can turn
around this cycle to create a positive cycle that will help
you overcome anxiety. One important step in this cycle is
gradually confronting feared situations. This will lead to an
improved sense of confidence, which will help reduce your
anxiety and allow you to go into situations that are
important to you.
Some people might encourage you to tackle your
biggest fear first – to “jump in the deep end” and
get it over and done with. However, many people
prefer to take it “step-by-step”. We call this
“graded exposure”. You start with situations
that are easier for you to handle, then work your way up
to more challenging tasks. This allows you to build your
confidence slowly, to use other skills you have learned, to
get used to the situations, and to challenge your fears
about each situational exposure exercise. By doing this in a
structured and repeated way, you have a good chance of
reducing your anxiety about those situations.
Coping Skills: Breathing & Thinking Better
When you are gradually confronting feared situations, there
will be a short term increase in anxiety. This is normal—
everyone feels anxious about doing things they fear. The
important thing to remember is that you can learn other
skills as alternatives to avoidance and safety behaviours.
There are other information sheets available which explain
these coping skills in more detail, but here they are briefly:
Breathing: Anxiety is often associated with fast, shallow
breathing, which contributes to the physical sensation of
anxiety. By slowing down your breathing and using calming
and relaxation techniques, you can reduce your anxiety.
Thinking: There are many types of negative thoughts
which are associated with anxiety, such as “I will not be
able to cope” or “I must avoid this situation.” Learning to
challenge these thoughts with more balanced ones can help
to reduce the experience of anxiety.
When the anxiety cycle is broken, it will look like this:
Reversing the Vicious Cycle of Anxiety
Confront feared
situations without aid of
safety behaviours
situations
Greater belief in Short term slight increase in
ability to control own anxiety, then a decrease in
responses physical symptoms and
attention scanning
Use of coping skills,
anxiety reduces to
manageable level
C entre for
the full disclaimer and copyright statement available at
http://www.cci.health.wa.gov.au regarding the information from
CI linical
nterventions
this website before making use of such information. •Psychotherapy•Research•Training
What is Cognitive Behavioral Therapy (CBT)?

The key idea behind cognitive behavioral therapy is that:

what you t h i nk and do affects the way you feel

CBT is ‘present focused’. That means it works with thoughts and feelings in the here-and-now.
A cognitive behavioral therapist will try to understand a situation by looking at separate parts:

Situation

Thoughts
what was going
through your mind?

Behaviors Emotions
what did you do? what were you
how did you react? feeling?

Bodily
Sensations
what was going
on in your body?

Sometimes, through no fault of their own, people get ‘stuck’ in vicious cycles: the things they
do to solve a problem can inadvertently keep it going.

“I’m useless”
“Nobody likes me”

fewer good Sad, demotivated

things happen

Retreat into my shell Tired, lethargic

Cut-off from other people

CBT is about finding out what is keeping us ‘stuck’ and making changes in our thinking and
actions in order to improve the way we feel. It is a collaborative therapy and needs your active
participation in order to be helpful. There is a lot of evidence to show it is an effective treatment.
PSYCHOLOGYT LS FREE http://psychologytools.com
 Thinking Errors

Ignoring the Good. You pay more attention to bad things, and
ignore when something good happens.

examples:
• You get one answer wrong on a long test, and all you can think
about is the mistake.
• You score two goals in your soccer game, but all you can think
about is the shot you missed.

Blowing Things Up. Making a really big deal out of something

small, or making something a little bit bad seem like the worst
thing ever.
examples:
• You get a stain on your new shoes and you think they’re ruined and
can’t be worn anymore.
• “I’m not allowed to see my friends on Friday. My life is horrible!”

Fortune Telling. Thinking you know what will happen in the

future, and that it will be bad.

examples:
• “I know if I ask her to the dance she’s going to say no.”
• “I bet no one will come to my birthday party.”

© 2018 Therapist Aid LLC 1 Provided by TherapistAid.com

 Thinking Errors

Mind Reading. Believing you know what someone else is

thinking, or why they are doing something, without having
enough information.
examples:
• “People are looking at me. They probably think my shirt is ugly.”
• “Emma didn’t invite me to her party. I bet she thinks I’m weird.”

Negative Labeling. Having a negative belief about yourself and

thinking it applies to everything you do.

examples:
• “I’m a loser so my artwork stinks.”
• “I’m so stupid. Everything I say is dumb.”

Setting the Bar Too High. Thinking that you must be perfect in
everything you do, otherwise you’re no good.

examples:
• “If I don’t get an A on every test, I’m not smart.”
• “I have to win every tennis match I play, otherwise I’m worthless.”

© 2018 Therapist Aid LLC 2 Provided by TherapistAid.com

 Thinking Errors

Self-blaming. Blaming yourself for anything that goes wrong

around you, even if you had nothing to do with it.

examples:
• When your basketball team loses a game, you think it’s entirely
your fault.
• “Alicia is sad today. I probably did something to upset her.”

Feelings as Facts. Believing that if you feel something, it must

be true.

examples:
• “I feel ugly, so I must be ugly.”
• “I feel like I’m a bad friend, so I must be a bad friend.”

“Should” Statements. Believing things have to be a certain way.

examples:
• “People should always be nice to me.”
• “I should always be happy. I should never be sad.”

© 2018 Therapist Aid LLC 3 Provided by TherapistAid.com

 What is Mindfulness?
Mindfulness: a state of nonjudgmental awareness of what’s happening in the present moment,
including the awareness of one’s own thoughts, feelings, and senses.

Components of Mindfulness

Awareness. During a state of mindfulness, you will notice your thoughts, feelings, and physical
sensations as they happen. The goal isn’t to clear your mind or to stop thinking—it’s to become
aware of your thoughts and feelings, rather than getting lost in them.

Acceptance. The thoughts, feelings, and sensations that you notice should be observed in a
nonjudgmental manner. For example, if you notice a feeling of nervousness, simply state to
yourself: “I notice that I am feeling nervous”. There’s no need further judge or change the feeling.

Benefits of Mindfulness

Reduced symptoms of Improved memory, focus, and Improved ability to adapt

depression and anxiety mental processing speed to stressful situations

Greater satisfaction Reduced rumination (repetitively Improved ability to

within relationships going over a thought or problem) manage emotions

Mindfulness Practice
Note: Mindfulness is a state of mind, rather than a particular action or exercise. However, without
practice, mindfulness is difficult to achieve. These techniques are designed to help you practice.

Mindfulness Meditation Mindfulness Walk

Mindfulness Walk
Sit in a comfortable place, and begin paying Whileblah
Blah walking,
blah. make a point
Blah blah to practice
blah. Blah blah blah.
attention to your breathing. Notice the physical Blah blah blah. Blah blah blah. Blahyour
mindfulness. Start by noticing how blahbody
blah.
sensation of air filling your lungs, and then moves
Blah and
blah feelsBlah
blah. withblah
eachblah.
step.Blah
Then, expand
blah blah.
slowly leaving. When your mind wanders— your awareness
Blah blah blah. to your surroundings. What do
which it will—simply notice your thoughts, and you see? Hear? Smell? Feel? This technique
turn your attention back to breathing. can also be expanded to other daily activities.

Body Scan Five Senses

Pay close attention to the physical sensations Make a conscious effort to notice the present
throughout your body. Start with your feet, and moment through each of your senses.
move up through your legs, groin, abdomen,
• 5 things you see • 1 thing you taste
chest, back, shoulders, arms, hands, neck, and
• 4 things you feel • 1 thing you smell
face. Spend anywhere from 15 seconds to 1
• 3 things you hear
minute on each body part.

© 2017 Therapist Aid LLC Provided by TherapistAid.com

 Deep Breathing
Deep Breathing: a relaxation technique performed by purposefully taking slow,
deep breaths. When practiced regularly, deep breathing provides both immediate
and long-term relief from stress and anxiety.

How Deep Breathing Works

During periods of anxiety, the body triggers a set of symptoms called the stress response.
Breathing becomes shallow and rapid, heart rate increases, and muscles become tense. In
opposition to the stress response is the relaxation response. Breathing becomes deeper and
slower, and the symptoms of anxiety fade away. Deep breathing triggers this response.

Instructions
Sit back or lie down in a comfortable position. Close your eyes, if you would like to do so. When
you’re learning, try placing a hand on your stomach. If you breathe deeply enough, you should
notice it rising and falling with each inhalation and exhalation.

1 Inhale. Breathe in slowly through your nose for 4 seconds.

2 Pause. Hold the air in your lungs for 4 seconds.

Exhale. Breathe out slowly through your mouth for 6 seconds.

3
Tip: Pucker your lips, as if you are blowing through a straw, to slow your exhalation.

4 Repeat. Practice for at least 2 minutes, but preferably 5 to 10 minutes.

Tips
• If it isn’t working, slow down! The most common mistake is breathing too fast. Time each
step in your head, counting slowly as you do so.

• Counting out your breaths serves a second purpose. It takes your mind off the source of your
anxiety. Whenever you catch your mind wandering, simply return your focus to counting.

• The times we use for each step are suggestions, and can be lengthened or decreased.
Lengthen the time if it feels natural to do so, or decrease the time if you feel discomfort.

© 2017 Therapist Aid LLC Provided by TherapistAid.com