Anxiety Workbook Quotes

An anxious mind cannot exist in a relaxed body.” Body and mind are inextricably related in anxiety.

It’s hard to evaluate the validity of a belief you’re scarcely aware of—you just accept it as is.

People have worried about things for centuries, but it has never once had a positive effect on the outcome of a situation.

Your truth matters. Your feelings are valid. Your experiences hold significance. Your trauma deserves attention. Please don't let anyone undermine your reality or your voice because you have the absolute right to experience and express your feelings without judgment or dismissal. Embrace your truth and honor your journey no matter how long it takes.

With agoraphobia you feel safe only when you are in certain environments. Your anxiety increases every time your ’safe place’ is unavailable, blocked, or becomes more distant.

Taking responsibility means you don’t blame anyone else for your difficulties. It also means that you don’t blame yourself.

We are so used to “doing” that it may seem like a chore just to “be.

For most people, disruptions in routine are simply annoying, but for someone with BPII, these types of disruptions may actually lead to depressive or hypomanic symptoms. In addition, research has found that individuals with bipolar disorder have more difficulty than the average person in maintaining a regular schedule (Shen et al. 2008).

BPII differs from the other main type of bipolar disorder, bipolar I (BPI), in two key ways. First, everyone with BPII experiences one or more periods of depression; however, depression may or may not be present in BPI. Second, people with BPII experience hypomania, a less severe version of mania, the episodic high or elevated mood that is the defining feature of BPI.

For example, an individual with BPII is more likely to have negative thoughts when stuck in traffic, such as My friend is going to be so mad at me because I will be late, and act in potentially unhealthy ways, such as driving recklessly or canceling the meeting, and thus feel more negatively (e.g., sad, angry, disappointed). In short, the biological tendencies of the individual with BPII are interacting with the situation to create a more negative outcome.

Although substance use helps in the short term to numb you to feelings of sadness or anxiety, in the long term it simply makes it more difficult to function from day to day. For example, although drinking several drinks every evening may help you cope with anxiety and help you to fall asleep, this same behavior almost always has a downside. You might find that you wake up very easily in the middle of the night, and that the anxiety you suffer when you are sober is even worse.

The problem with the Be-Good mindset is that it tends to cause problems when we are faced with something unfamiliar or difficult. We start worrying about making mistakes, because mistakes mean that we lack ability, and this creates a lot of anxiety and frustration. . . . The Get-Better mindset, on the other hand, is practically bullet-proof. When we think about what we are doing in terms of learning and mastering, accepting that we may make some mistakes along the way, we stay motivated despite the setbacks that might occur.

BPII is considered a biological illness because it is associated with structural and functional abnormalities in the brain. In recent years, psychologists have learned much about how the brain of someone with BPII differs from that of someone without the disorder; however, because the brain is very complex, there is still a lot that we do not understand. We know that BPII is caused, at least in part, by problems with the brain’s chemical messengers, or neurotransmitters. But it seems that each person with BPII may have slightly different problems with his or her neurotransmitters and we don’t yet understand exactly what these differences are.

Bipolar II disorder is a highly misunderstood form of bipolar illness. By its very designation as type II, clinicians, patients, and the public often assume it is less impairing than bipolar I, “the real thing.” When we examine the diagnostic criteria for bipolar II, they sound very mild. Who doesn’t get sad and happy? Who doesn’t have mood swings? Why would a four-day period of excess energy, which does not affect the ability to function, be of any clinical importance? Several longitudinal studies have found that bipolar II is far more impairing than we once thought. It is characterized by lengthy and recurrent periods of depression, comorbid anxiety disorders, and high rates of substance and alcohol misuse. The occasional hypomanias of bipolar II—in which people experience elation and irritability, exuberance, increased energy, and reduced need to sleep—are not as impairing as the full manic episodes of bipolar I, but they can certainly have a negative impact on family members and friends. Moreover, for the person with the disorder, these high periods are often short-lived, and they do little to alleviate the suffering caused by depressive phases. The hypomanic periods may even overlap with the low phases, resulting in an agitated, anxiety-ridden, and highly distressing period of depression. People with bipolar II often have difficulty maintaining jobs and relationships, and, like people with bipolar I, they are at high risk for suicide.

nutritional supplement worth considering is 5-HTP (5-hydroxytryptophan). It has been shown to be highly effective in moderating many behavior problems, including aggression, with far fewer or less problematic side effects than the heavy-duty prescription medications. It is surprising that veterinarians are not more familiar with this supplement, and that they do not take greater advantage of it, given its effectiveness, its relatively low cost and that it works as soon as it is taken (unlike many medications, which can take weeks to build up an effect). It should not be used in conjunction with medications that affect serotonin activity. The correct dosage is determined experimentally. If the dose is slightly high, the dog may be initially nauseous. If the dose is too low, no effects will be achieved. The dose used at Tufts University School of Veterinary Medicine for addressing aggression is 2 mg/kg, administered orally every 12 hours. If 5-HTP is used, you should watch for signs of serotonin syndrome (caused by an excess of serotonin activity in the brain). These include confusion/disorientation, agitation/irritability, low responsiveness/coma, anxiety, hypomania (elevated mood and increased activity), lethargy and seizures (Sorenson, 2002). You should also be on the lookout for these signs with the use of medications that influence serotonin activity.

This book is different from similar workbooks because of its focus on BPII, which is treated and managed differently than BPI. This book also includes strategies for managing anxiety, which frequently co-occurs with BPII. Finally, as opposed to other books, in this book we present strategies from several different psychotherapeutic approaches, such as cognitive behavioral therapy (CBT), family-focused treatment (FFT), and dialectical behavior therapy (DBT). Although some of these skills were developed from research studies involving people without bipolar disorder, we will show you how they can be applied to the specific needs of people with BPII.

You may have heard people say that they feel “manic” on days when they have high energy or are in a particularly cheerful mood, perhaps even experiencing some of the manic symptoms listed in table 1.1, but this is not necessarily mania. For example, over the holidays, people may report feeling very happy and excited, have increased energy, sleep less than usual, and talk more than usual. If these “symptoms” last more than seven days, are these people actually experiencing mania? Certainly not! So, what is the difference between periods of good mood, or high energy, and mania? The difference is that when you are experiencing mania, your symptoms make it difficult for you to fulfill your responsibilities with regard to work, to friends and family, or to yourself (self-care). In other words, the symptoms associated with a manic episode interfere with your ability to function (e.g., to work, to pay bills, to take care of children, to see your friends, to accomplish daily tasks), which causes problems for you (e.g., you show up late for work, you’re not able to pay bills, your relationships with friends and family suffer, you can’t accomplish daily tasks).

The diathesis-stress model suggests that diseased conditions, such as BPII, are affected by both people’s genes (i.e., biological causes) and their environment (Ingram and Luxton 2005). Another way to think about this phenomenon is to picture two people who are stuck in traffic and are late for a meeting; one of these individuals has BPII and the other does not. The diathesis-stress model suggests that the individual with BPII is more likely to be negatively affected by this stressful situation than the person without BPII. In other words, due to his or her biology, the person with BPII may have a lower threshold for tolerating negative events.

Unfortunately, you may be less likely to keep a daily routine because you have BPII. IPSRT is a skills-based psychotherapy that addresses this issue. IPSRT focuses on recognizing the association of stress and mood, stabilizing daily routines (i.e., social rhythms), and identifying and managing affective symptoms. In addition, it teaches skills that help resolve interpersonal problems (Frank 2005; Frank, Swartz, and Kupfer 2000).

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down to the family or person in question. Besides medication and therapy, it is important to have a healthy lifestyle when dealing with ADHD symptoms. It is often recommended that those with ADHD focus on building healthy eating habits, getting in as many vegetables, fruits, and whole grains as they should. Protein should also come from lean sources. Daily physical exercises or routines also help and should be designed with the age and capabilities of the person in mind. It helps to have less time with screens, whether television, cellphones, or any other electronic device. Also, adequate sleep does amazing things for the ADHD mind.

Neurodivergent Checklist Time Blindness: Many neurodivergent people have trouble properly perceiving time as it passes. It either goes by too quickly or slowly. The perception of time depends on the level of stimulation the neurodivergent person is dealing with. It also can vary depending on what you’re focused on. If you’ve ever found yourself unable to account for time, you may be neurodivergent. Executive Dysfunction: This is what you experience when you want to accomplish a task, but despite how hard you try, you cannot see it through. Executive dysfunction happens for various reasons, depending on the type of neurodivergence in question. Still, the point is that this is a common occurrence in neurodivergent people. Task Multiplication: What is task multiplication? It happens when you set off to accomplish one thing but have to do a million other things, even though that wasn’t your original plan. For instance, you may want to sit down to finish some writing, only to notice water on the floor. You get up to grab a mop, and on the way, you notice the laundry you were supposed to drop off at the dry cleaners. Stooping to pick up the bag, you find yourself at eye level with your journal and remember you were supposed to make an entry the previous day, so you’re going to do that now. On and on it goes. Inconsistent Sleep Habits: This depends on what sort of neurodivergence you’re dealing with and if you’ve got comorbid disorders. Most importantly, neurodivergent people sleep more or less than “regular” people. You may also notice that your sleep habits fluctuate a lot. Sometimes you may sleep for eight hours at a stretch for a week, only to suddenly start running on just three hours of sleep. Emotional Dysregulation: With many neurodivergent people, it’s hard to keep emotions in check. Emotional dysregulation occurs in extreme emotions, sudden mood swings, or inappropriate emotional reactions (either not responding to the degree they should or overreacting). Hyperfixation: This also plays out differently depending on the brand of neurodivergence in question. Often, neurodivergent people get very involved in topics or hobbies to the point of what others may think of as obsession. Picking Up on Subtleties but Missing the Obvious: Neurodivergent people may struggle with picking up on things neurotypical people can see easily. At the same time, they are incredibly adept at noticing the subtle things everyone else misses. Sensory Sensitivities: If you’re neurodivergent, you may be unable to ignore your clothes tag scratching your back, have trouble hearing certain sounds, and can’t quite deal with certain textures of clothing, food, and so on. Rejection Sensitivity: Neurodivergent people are often more sensitive to rejection than others due to neurological differences and life experiences. For instance, children with ADHD get much more negative feedback than their peers without ADHD. Neurodivergent people are often rejected to the point where they notice rejection even when it’s not there.

Trouble Making and Maintaining Eye Contact: Neurodivergent people may not always do well with eye contact. For some, it can appear as though they’re staring right into your soul, which is something not many people are comfortable with. Other neurodivergent people find eye contact distracting and uncomfortable, so they’ll opt to look everywhere but at you. Rich Inner World vs. The Outer World: Neurodivergent people often tend to be in their heads. They feel things more deeply than neurotypical people and tend to think a lot more.

Narrow Stimulation Range: With neurodivergence, you’re either easily underwhelmed or overwhelmed. There’s no balance where you sense enough to hold your interest but not so much that you’re overwhelmed by what’s happening. Low Tolerance for Frustration: You’re probably neurodivergent if you think that trying things once and failing means you should never try again. The reason this happens is that neurodivergent people learn differently from neurotypical ones.

Being Motivated by Shame: Neurodivergent people don’t learn as others do and are shamed for how they learn and their choices in life. So, they discover that shame is a driving force for learning and other accomplishments. This shame isn’t something neurodivergent people are born with. Instead, it’s something that is beaten into them as the years go by, and society continues to tell them they’re broken — which is not true. Stimming: Stimming refers to any action that’s meant to help the neurodivergent person feel stimulated for whatever reason. There are all kinds of stims, from vocal to tactile. Stimming helps to alleviate boredom and to regulate and express emotions as needed. Examples of stimming include throat clicking, finger-snapping, rocking back and forth, running hands through hair, pacing, repeating sounds or words, and so on.

The first category needs to be done, the second needs to be planned for, the third can be delegated, and the final category doesn’t need to be handled. However, with the neurodivergent brain, since there’s no “assistant,” everything winds up on the exec’s desk vying for their attention. As a result, either the wrong thing gets done, or nothing gets done at all.

left untreated, and so as they grow up, they face issues like anxiety, mood swings, an antisocial personality, and when they approach adulthood, they face other comorbid disorders as well.

IF YOU ARE INTERESTED IN MBSR AND ITS APPLICATIONS IN THE WORLD Full Catastrophe Living Coming to Our Senses Heal Thy Self Here for Now A Mindfulness-Based Stress Reduction Workbook Mindfulness-Based Cancer Recovery Teaching Mindfulness Mindfulness IF YOU ARE INTERESTED IN MINDFULNESS-BASED COGNITIVE THERAPY AND ITS APPLICATIONS Mindfulness-Based Cognitive Therapy for Depression The Mindful Way Through Depression The Mindful Way Through Anxiety Mindfulness-Based Cognitive Therapy for Cancer Mindfulness-Based Cognitive Therapy for Anxious Children Mindfulness IF YOU ARE INTERESTED IN MINDFULNESS IN POLITICS AND ITS APPLICATIONS IN PUBLIC LIFE The Mindfulness Revolution A Mindful Nation OTHER APPLICATIONS OF MINDFULNESS Mindful Eating Eat, Drink, and Be Mindful Mindful Birthing The Mindful Child Living in the Light of Dying

Since meditation helps lower stress levels, it can become an essential component in managing chronic health issues like anxiety, chronic pain, insomnia, hypertension, inflammatory illnesses, tension headaches, and autoimmune disorders.

In addition, because compulsions provide short-term relief from anxiety, they reinforce the obsession’s perceived validity. Each time you respond to an obsession with a compulsion, you confirm the belief that the fear is “dangerous” and repetitively set off the FFF response. Ironically, when you perform a compulsion, you are also more likely to experience the return of that obsession, because the compulsion is a reminder of the obsession itself.

control of your pain dial by managing (1) stress and anxiety, (2) mood, (3) attention, (4) interpretations and understanding of pain, and (5) coping behaviors.

Men are often inclined to present anxiety in ’secondary’ emotional, physical, or behavioral ways. In other words, anxiety often sits beneath some other form of presentation; for example, expressing anger or aggression (a secondary emotion) rather than conveying fear or apprehension (a primary emotion). This is because anger is, hypocritically, a more socially accepted form of emotional expression for men than for women. In men, anxiety may express itself in secondary emotional or physical forms such as: • Anger • Irritability or ’being on edge’ • Restlessness • Depressed mood • Fatigue and/or burnout • Difficulty concentrating or being present • Sexual health issues (such as erectile dysfunction) Men are also more inclined to adopt compensatory behaviors that serve as coping strategies for their anxiety, such as: • Antisocial behavior or withdrawing • Risky behaviors or activities • Addictive behaviors (such as pornography or gaming) • Substance abuse

once we become convinced that a negative health outcome is inevitable, any physical sensation we perceive can seem indicative of illness and worthy of panic.

hypochondriasis no longer appears as a diagnosable disorder. In its place are two distinct disorders: somatic symptom disorder and illness anxiety disorder.

1.          They were perfect… initially. We’ve discussed this one, but it’s worth mentioning again. A narcissist wants you to believe they’re totally into you and put you on a pedestal. Once they have you, though, they stop trying as hard and you end up being the one working to keep them. 2.          Others don’t see the narcissist the way you do. It’s hard enough to see it yourself, but when those around you, especially their friends and family, make excuses for them, you start doubting yourself even more. Stick to what you see. 3.          They’re making you look bad. In order to maintain their facade of perfection, they make you look like a bad person. Usually this involves spreading rumors, criticizing you behind your back, or creating lies you supposedly told. The worst part is that when you try rectifying the situation, or laying the blame where it should belong, the narcissist uses your defense to back their own lies. It’s frustrating because the generous, wonderful person they displayed initially is what those around you still see, even if you see them for who they really are. 4.          You feel symptoms of anxiety and/or depression. The toxic person may have caused you to worry about not acting the way you’re expected to, or that you haven’t done something right or good enough. In making this person your entire world, you may lose sleep, have no interest in things you used to or have developed a, “What’s the point?” attitude. You essentially absorb all of the negative talk and treatment so deeply, you believe it all. This is a dangerous mindset to be in so if you feel you’re going any steps down this path, seek outside help as soon as possible. 5.          You have unexplained physical ailments. It’s not surprising that when you internalize a great deal of negativity, you begin to feel unwell. Some common symptoms that aren’t related to any ongoing condition might be: changes in appetite, stomach issues, body aches, insomnia, and fatigue. These are typical bodily responses to stress, but if they intensify or become chronic, see a physician as soon as you can. 6.          You feel alone. Also a common symptom of abuse. If things are really wrong, the narcissist may have isolated you from friends or family either by things they’ve done themselves or by making you believe no one is there for you. 7.          You freeze. When you emotionally remove yourself from the abuse, you’re freezing. It’s a coping mechanism to reduce the intensity of the way you’re being treated by numbing out the pain. 8.          You don’t trust yourself even with simple decisions. When your self-esteem has been crushed through devaluing and criticism, it’s no wonder you can’t make decisions. If you’re also being gaslighted, it adds another layer of self-doubt. 9.          You can’t make boundaries. The narcissist doesn’t have any, nor do they respect them, which is why it’s difficult to keep them away even after you’ve managed to get away. Setting boundaries will be discussed in greater detail in an upcoming chapter. 10.    You lost touch with the real you. The person you become when with a narcissistic abuser is very different from the person you were before you got involved with them. They’ve turned you into who they want you to be, making you feel lost and insecure with no sense of true purpose. 11.    You never feel like you do anything right. We touched on this briefly above, but this is one of the main signs of narcissistic abuse. Looking at the big picture, you may be constantly blamed when things go wrong even when it isn’t your fault. You may do something exactly the way they tell you to, but they still find fault with the results. It’s similar to how a Private feels never knowing when the Drill Sergeant will find fault in their efforts. 12.    You walk on eggshells. This happens when you try avoiding any sort of conflict, maltreatment or backlash by going above and beyond to make the abuser happy.

Self-destructive behavior: When someone has been in a controlling relationship long enough, they carry on with the feelings of shame and fault even after the relationship has ended. This can flow over into forms of self-harm and substance abuse to continue with what the abuser did to them. ●     Overly obliging: Being forced to make the needs and wants of another person a number one priority from wake up until bedtime can result in extending the people-pleasing into other areas of your life. ●     Trust issues: Being mentally abused to the point where a person doubts themselves, or doesn’t even trust themselves or others, it can create severe trust issues. This can even lead to more severe concerns such as social anxiety. It instills mistrust of what others say, what they really mean and their sincerity. ●     Emotionally disconnected: It’s not uncommon to not understand how to emotionally respond to situations or people, or even express emotions at all. ●     Cognitive issues: This can be the result of the ill-treatment itself or the physical symptoms impairing health. Lack of sleep can result in many of the symptoms listed earlier as can digestive issues. Additional concerns also include memory loss, inability to concentrate, losing focus performing basic tasks or “spacing out”. ●     Inability to forgive the self: Feelings of unworthiness, shame and blame dissipate over time they never completely go away. Similar to PTSD, one small trigger can be all it takes to relive the trauma. Another aspect of this is a damaged self-worth that causes us to not make an effort to reach goals or dreams, or we self-sabotage because we’re convinced we don’t deserve happiness or success.

do you feel you have difficulty forming connections with others? Do you find yourself feeling lonely, even when surrounded by people? Are you struggling to find a sense of security in your relationships? If so, you are not alone.

Childhood development encompasses a child’s growth and changes from birth until adulthood. This process is often divided into five main areas: physical, emotional, intellectual, social, and spiritual.

Humans have an innate need to form and maintain close relationships with others. Our attachment style largely influences the way we approach and experience these relationships.

remember that self-awareness and compassion are key to overcoming an anxious attachment style. By understanding the root causes of our attachment patterns, we can begin to heal old wounds and form healthier, more fulfilling relationships.

However, with awareness and support, individuals with an anxious attachment style can learn to manage their anxiety and form healthy, fulfilling relationships. Therapy, self-reflection, and building healthy communication skills can help you to work through anxious attachment patterns.

For example, if you grew up feeling like your needs were often ignored or dismissed, you may have developed an anxious attachment style. You may struggle with trust and feel insecure in your relationships, constantly seeking validation and reassurance from romantic partners.

The neurodivergent brain is like an exec without an assistant.

look at your trauma and see it for what it is - a combination of thoughts and feelings.

I find acceptance to be the key that unlocked my mental cage, freeing me from the mental and emotional suffering I've been carrying for years.

A dysregulated nervous system is the most confining prison that can trap you. But if you can understand the bodily cues of safety and danger, you can learn how to regulate your responses and harness the most effective key to free your mind.

VITAL Action As you take action on your social-anxiety playing field, you can use the following skills to guide you in each and every action: V Identify your values and goals. (Hint: Values guide your actions and are never “finished”; goals are things you can check off and say you’re done with.) I Remain in the present moment, first anchoring your attention to the breath and then shifting your focus to, and staying fully present with, what really matters in the situation; revisit your anchor as needed when your focus drifts from the present moment. T Take notice of your experience from your observer perspective (perhaps embodying your inner mountain or another observer image), noticing feelings, thoughts, and urges to use safety behaviors (including avoidance). AL Allow your experience to be exactly as it is, with the assistance of metaphors (flip on your willingness switch, drop the rope, welcome Uncle Leo, and so on) and defusion strategies (labeling, thank your mind, and so on). Try bringing attitudes of curiosity, openness, compassion, and acceptance to your experience.

For most people, disruptions in routine are simply annoying, but for someone with BPII, these types of disruptions may actually lead to depressive or hypomanic symptoms. In addition, research has found that individuals with bipolar disorder have more difficulty than the average person in maintaining a regular schedule (Shen et al. 2008). Does this ring true for you? During times of stress, is it harder for you to maintain a daily schedule? How do you feel when you have no daily structure or routine? Perhaps you oversleep, skip meals, watch TV late at night, or overeat. How do these feelings and behaviors affect your mood?

Unfortunately, you may be less likely to keep a daily routine because you have BPII.

Most of our decisions and achievements are based on our thoughts. Our thoughts influence our behaviors.

Fear is more of a present-moment emotional experience. Fear is what you experience when you are actually in a stressful or threatening situation.

Anxiety, on the other hand, is more of a future-focused emotion.

One emotion is about the anticipation of an event, and the other is about the actual experience of that event.

Indeed, David Barlow, a leading expert in the treatment of anxiety disorders, has said that one of the most important things people with anxiety problems can do is to learn to stop avoiding their emotions

LEARNING TO

Once you can comfortably walk three or four miles without stopping, consider taking hiking trips—day or overnight—in county, state, or national parks. Hiking outdoors can revitalize your soul as much as it does your body.

If you encounter a trigger, breathe and move through your five senses. Observe and describe what you see, hear, smell, taste, and feel. You can also use the acronym STOP—Stop, Take a breath, Observe what’s going on around you, and Proceed (i.e., move forward with what you were doing before the trigger caught your attention).

Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances.” —Victor E. Frankl, Austrian psychiatrist

Common sense indicates that some people are not mature enough to properly handle your most confidential disclosures; so in those circumstances, it is best to avoid certain disappointment. Furthermore, you will have some casual relationships that are not necessarily unhealthy, but you may not have the time required to develop them at the deepest levels. That, too, may be a valid reason to hold back in self-disclosures. Even in the relationships that are not conducive to complete openness, though, you need not retreat into a style of relating that requires you to keep up a false front. A good rule of thumb for avoiding an unnecessary buildup of anxiety is to find a few people you can trust with full disclosure, and with everyone else, maintain a calm, yet candid, attitude that indicates you accept yourself just as you are. As a simple illustration, when Judy told Dr. Carter that she didn’t like being known as a divorcée, he replied to her, “I can appreciate that this is something you don’t like about your life’s script. Nonetheless, that’s where you are. The sooner you can be straightforward about that reality, the better off you will be emotionally.” How about you? What facts about your life do you try to hide? (For instance, “I don’t talk to anyone about the fact that my son has a drug problem” or “I’ve kept it secret for years that I was pregnant when I married my husband.”)

A major depressive episode, often called “depression” or “clinical depression,” means that you have felt down or sad, or much less interested in things than usual, for most of the day, nearly every day, for at least two weeks. In addition to feeling sad or less interested in things, you have at least four other depressive symptoms

Hypomania is characterized by a persistently irritable, elevated, or expansive mood, accompanied by at least three of the other hypomanic symptoms (or four with irritable mood) listed in table 1.1, over most of the day for at least four days. You may notice that the symptoms listed for hypomania and mania in table 1.1 are the same. Hypomania differs from mania in that such an episode is typically shorter and is less severe, given that it does not impair functioning. Once the symptoms impair functioning, the episode is almost always considered a manic episode, unless it is only brief (e.g., less than seven days).

A few tips to help you further distinguish hypomania is to remember that hypomania is abnormally high or irritable mood, meaning different from what a person usually experiences when happy or upset/irritable. Hypomanic episodes also last for at least four consecutive days. Thus, this abnormally high or irritable mood persists for several days and is accompanied by at least three (or four, if the mood is irritable) of the manic/hypomanic symptoms in table 1.1 for the same four days. Finally, in order to be diagnosed with BPII, you must have also experienced a major depressive episode at some time in your life.

DBT was originally developed to help individuals with borderline personality disorder. However, it has been adapted to successfully treat other conditions, such as eating disorders (e.g., Safer, Telch, and Agras 2001; Telch, Agras, and Linehan 2001), suicidality (Rathus and Miller 2002), and depression (Lynch et al. 2003). We the authors of this book, along with our colleagues, have also started using DBT skills in the MGH Bipolar Clinic and Research Program, with promising early results (Eisner et al. 2011).

Adolescents and adults with bipolar disorder who received the skills taught as part of FFT had fewer mood episodes, longer periods of feeling well, and greater improvements in depressive symptoms compared to bipolar individuals who did not receive FFT (Miklowitz et al. 2000)

Rather, allow yourself to experience the anxiety and work through the feeling, even if it’s uncomfortable. Notice and describe the way anxiety feels in your body, but don’t try to do anything about it. Just observe and see what happens.

The important thing is to start to build a tolerance for uncertainty by facing it, rather than avoiding it. When facing uncertainty, if uncomfortable feelings arise, try to stay with them, observe, and tolerate them, and don’t judge yourself for experiencing anxiety when facing uncertainty or the unknown.

Positive Thinking “Watch your thoughts; they become words. Watch your words; they become actions. Watch your actions; they become habits. Watch your habits; they become character. Watch your character; for it becomes your destiny.

Attention in Action Over time, a daily practice—even if it’s just for a few minutes—will help you focus your attention and observe your thoughts and sensations. This process, called attention in action, can help you manage your anxiety by teaching you to stay in the present moment instead of being distracted by worries about the past or fears about the future. Attention in action is not just a part of your daily practice; it’s a state of mind to cultivate throughout the day.

Instead of passively giving in to a welter of conflicting thoughts, you can choose instead to actively focus your attention and observe your thoughts and sensations. If you do this compassionately, you will begin to see how and where your thoughts connect and relate to one another. In turn, this process will help you reduce your anxiety.

Anxiety interferes with presence because it takes you out of the current moment. Anxiety changes your posture—it makes you tense, awkward, or even slumped over, as your shoulders tighten. People with straighter postures are seen as more appealing than those who slouch (Mehrabian and Blum 1997). Slouching conveys a shut-down, uninviting body language to observers and makes the sloucher feel shut down as well.

A distressed person may hold on to destructive thoughts and beliefs with great conviction. With help, an anxious person can learn to view negative beliefs as hypotheses rather than facts and to test them out by running “experiments” that try out new ways of thinking and behaving.

When you worry, your mind is busy, and so your body becomes activated and energized. This active state makes you feel as if you are doing something constructive. For example, let’s say you are throwing a party

In the moment, all of this anticipatory anxiety keeps you actively engaged in your fears, which makes you feel as if you are in control of them. However, there is nothing actually being accomplished. As noted above, no matter how much energy you expend on worry, it accomplishes nothing other than putting you into this futile activated state, which only leaves you feeling exhausted.

Worry should not be confused with logical problem solving. The difference is that worry actually constricts our thinking rather than opening it up to possible solutions. Instead of moving toward productive outcomes and the resolution of a problem, worry just keeps us going around in circles.

That’s where Y-CBT comes in. Y-CBT seeks to break this ping-pong cycle by simultaneously addressing the physical and cognitive symptoms of anxiety.

Remember that excess carbon dioxide confuses the body into thinking it’s suffocating and triggers rapid, shallow breathing, which keeps the cycle going!

WAFs, along with other emotional pain and hurt, are not your enemies. They are your teachers. Think about that for a moment. Without experiencing disappointment, you’d never learn patience. Without the hurt and frustration you receive from others, you’d never learn kindness and compassion. Without exposure to new information, you’d never learn anything new. Without fear, you’d never learn courage and how to be kind to yourself. Even getting sick once in a while has an important purpose—strengthening your immune system and helping you to appreciate good health.

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Habits of the mind influence our lives. What you think affects how you feel. Your thoughts are of your own making. Because you are the only one who is thinking your thoughts, you can choose to create habits of the mind that claim your self-value and give you freedom from anxiety.

You may need to simply accept the situation and do nothing for the moment. And sometimes, there is nothing that you can do to change your circumstances. The goal is to learn to stay calm when you have a problem to solve and do the best you can to work through it. Worry and rumination will not help you with that.

Daily Living Practice Your practice this week is to deepen your awareness of what happens in your mind and your body when you are anxious, and to work on quieting your patterns of worry. As you go through each day this week, remind yourself to: Notice your worry patterns and begin to change them by challenging the fear with facts. Practice Powering Down to Transform Anxiety to experience the state of having a quiet mind and a quiet body. Comfort yourself, and challenge yourself to be victorious as you face small and large stresses throughout the week. Read the inspirational quote you have written on the index card. Daily Practice Log Sunday Monday Tuesday Wednesday Thursday Friday Saturday Time of Day B A B A B A B A B A B A B A Yoga/Meditation I Used Y-CBT Techniques I Used B = Before, A = After 1 2 3 4 5 6 7 8 9 10 Low Anxiety Moderate Anxiety High Anxiety

The increased prevalence of anxiety, depression, and hypertension are the physical evidence of stress.

Workaholism is an addictive disorder in which work is the only thing that gives you a sense of inner fulfillment and self-worth.

Although in the West yoga is usually thought of as a series of stretch exercises, it actually embraces a broad philosophy of life and an elaborate system for personal transformation. This system includes ethical precepts, a vegetarian diet, the familiar stretches or postures, specific practices for directing and controlling the breath, concentration practices, and deep meditation.

the line in front you. It may not even be that specific. Did you experience failure because you followed the rules and someone didn’t? Are you upset about this because you think you should have done the same? Or should everyone else have behaved like you? Here, your past experiences empower your precipitation of things. You make these forms of attributions because

Our fears are wired into our brains. Everyone has them. Can you pinpoint or identify your fears? Listen to the feelings you have, and find, at the core, any fear or anxiety that involves being rejected or abandoned by your partner. To help you get in touch with your internal experience, here are a few of the common feelings or qualities of demanders and withdrawers. Check off the ones you resonate with. DEMANDERS OFTEN FEEL: Frightened of their aloneness; scared they’re not wanted Afraid of being abandoned Frightened of their feelings of hurt Scared of being invisible WITHDRAWERS OFTEN FEEL: Frightened of rejection Scared of their experience of disappointing their partner — coming up short Afraid of failure Overwhelmed Numbed or frozen with fear Afraid of being judged or criticized Reflect on what scares you most.