Managing
Panic
Workbook
0
Course Contents:
Session 1: What is Panic?.........................................03
Session 2: Controlling our Actions............................06
Session 3: Controlling our Thoughts Part 1...............10
Session 4: Controlling our Thoughts Part 2...............16
Session 5: Maintenance & Learning How to Relax....19
The Managing Panic course provides treatment for
symptoms of panic, and is based upon principles of
Cognitive Behavioural Therapy (CBT).
The course consists of five weekly sessions, each
focused on a different topic relevant to panic.
Please do make use of this workbook throughout the
course, as it provides the worksheets and resources
required to put the course contents into action.
The weekly tasks will help you to implement new skills
and techniques by practising them in-between sessions.
1
Cognitive Behavioural Therapy (CBT)
Cognitive - our thoughts and how we perceive the world
Behaviour - what we do and how we respond to the world
Therapy - to change / heal
CBT helps you take an overwhelming situation, break it
down into manageable parts, and change them.
CBT is evidence-based, and only uses techniques that
have been proven to work.
How Does CBT Work?
CBT is about making a change, either in the way we think
or what we do.
If you don't make a change, things will not improve.
CBT provides us with practical strategies anyone can learn,
and the more you use them the more effective they are.
We don’t expect these strategies to immediately resolve
all your problems, it takes time for you to become strong
in using them and you will need to maintain them once
the course finishes.
2
Panic: Identifying the Signs & Symptoms
To do this we use the Five Areas Model:
SITUATION Where? When? Who with? What?
THOUGHTS What went through my mind at
that time?
BEHAVIOURS What did I do as a result of this? EMOTIONS What emotion(s) did I feel at that
time?
PHYSICAL SENSATIONS What did I notice
happening to my body?
3
Keeping a Panic Diary
Date & Situation Panic Physical Thoughts Behaviour
Time What? Intensity Symptoms What did I What did I
Where? Out of in the order I think was do?
Who? 100% noticed them happening?
4
Session 1 Notes
This Week:
Complete your Five Areas Model
Complete your Panic Diary
5
Anxiety Ladder
100% Anxiety -
90% Anxiety -
80% Anxiety -
70% Anxiety -
60% Anxiety -
50% Anxiety -
40% Anxiety -
30% Anxiety -
20% Anxiety -
10% Anxiety -
0% Anxiety -
6
Keeping an Anxiety Diary
• To build tolerance to a situation, we need to experience it.
• Starting at the bottom of your anxiety ladder, plan when you will try your
activity, and practise doing it.
• Then use the anxiety diary to record your progress as this happens.
Anxiety Anxiety Anxiety
Situation &
Before During After Comments:
Duration
(0-10) (0-10) (0-10)
7
Graded Exposure – Remember the Rules:
GRADED
Remember to rank all the activities on the anxiety ladder, in order of how
badly they effect us, with the most anxiety-provoking at the top, and the
least anxiety-provoking at the bottom.
REPEATED
Keep doing the same step of your anxiety ladder until the exercise no longer
makes you feel anxious, for example, if your initial anxiety score is below 5
when you are rating your anxiety out of 10 before the exercise.
FREQUENT
Graded exposure needs to be completed at least 4-5 times a week.
DURATION
You need to stay in the situation long enough that you notice your anxiety
starts to decrease.
Remember...
Start with the least anxiety-provoking activities
You don’t have to do it alone
Don’t go too far too fast
Add as many steps as you need
8
Session 2 Notes
This Week:
Complete your Anxiety Ladder
Plan and put into practice the activities on your anxiety ladder,
remembering to start with the least anxiety-provoking activity/situation
Record your progress in your Anxiety Diary
9
Negative Automatic Thoughts (NATs)
What are NATs?
A stream of thoughts that occur automatically and quickly.
They are negatively framed interpretations of what we think is
happening to us.
They usually have a more negative impact on our mood and our
feelings.
They can lead to anxiety, low mood, self-doubt, anger, and
irritability.
They are not that helpful or useful, and yet we all have them.
How do we Identify NATs?
They are always negative
They make you feel bad about yourself
They are uninvited
They are believable
They are biased
They are often exaggerated
They seem real at the time but we question them later
How do we begin to Challenge NATs?
The difference between whether we accept and believe them, or
ignore or challenge them, will have an influence on how mentally
healthy and happy our lives will be.
We cannot challenge NATs unless we do something to catch them
and pay attention to them.
The way we start doing this, is by labelling them as different types
of NATs through different unhelpful thinking styles.
10
What’s your Thinking Style?
Have a look and circle the thinking styles you suit most often...
TYPE OF
THINKING EXPLANATION EXAMPLE
STYLE
1. Thinking in extreme terms with no - I need to do something
All or Nothing middle ground. Sometimes also perfectly or it’s a complete
known as black and white thinking waste of time
- Everybody hates me
2. Evidence is drawn from one - Bad things are always
Overgeneralising experience or from a small set of happening to me
experiences to reach an unwarranted - People never listen to me
conclusion with far reaching
implications
3. Paying attention to the negative - This week has been terrible,
Mental Filtering interpretation of a situation and not I can’t think of anything good
the other potential interpretations that’s happened
4. Positive or even neutral information is - Anyone can do that
Discounting The ignored, disqualified or viewed as an - People are only nice to me
Positive exception to the rule because they feel sorry for
me
5. Negative and pessimistic predictions - I’ll never get over this
Jumping To about the future - I will never feel different
Conclusions
6. ‘Worst case’ thoughts and images - If I go on the tube, I’ll have a
Catastrophising enter your mind, exaggeration the panic attack and collapse
consequences of what might happen - If I tell her how I feel, she’ll
leave me and I’ll be left alone
11
7. Emotional Assuming that negative emotions - I feel it, therefore it must be
Reasoning necessarily reflect the way things are true
in reality - I’m very scared, so the
situation must be dangerous
8. Mind Reading Assuming that we know others - He doesn’t like me
thoughts, intentions or motives - They think I’m stupid
9. Demands Rigid rules you place on yourself, or - I should do X Y Z
others which may not help you to - I must never make mistakes
accept and adapt to what’s actually - They should do X Y Z
happened
10. Labelling Specific shortcomings or failures are - Because I failed the exam,
identified with the individual character I’m a failure
- He’s a total idiot for saying
that
11. Personalising Giving yourself too much responsibility - If people don’t enjoy
for a negative event, when it may have themselves at my party, its
little or nothing to do with you my fault
- He’s being quiet because
I’m boring
12. Low Telling yourself that a difficult - I can’t stand it
Tolerance experience or a painful feeling is - I cant carry on
unbearable or intolerable
Remember:
We all use unhelpful thinking styles from time to time.
Sometimes one thought may reflect more than one of the thinking
styles.
12
Keeping a Thought Diary
Writing down our thoughts in a diary makes it easier to figure out
what type of thinking style we have used.
It is important to write our thoughts down because:
• It slows our thoughts down
• It helps us focus
• It helps us remember
• It helps us process
What is my Thinking
Situation What am I Thinking?
Style?
13
Thought Challenging
This step involves gathering evidence for and against the accuracy of
your chosen thought, much like a court case.
By gathering evidence both for and against the thought we are able
to assess whether the thought is realistic or helpful.
The evidence has to be real facts, not opinion or speculation.
Evidence For? Evidence Against? Balanced Thought
14
Session 3 Notes
This Week:
Record any NATs in your Thought Diary
Consider your Thinking Style
Use Thought Challenging to assess the accuracy of your thoughts, to
create more balanced thoughts
15
Behavioural Experiments
Testing Thoughts – Part 1
What’s the situation?
What’s my thought?
How much do I believe it? %
How can I test it? Where? When? Who with?
What do I fear will happen? What could happen instead?
What barriers are in my way? How can I overcome them?
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Testing Thoughts – Part 2
What actually happened?
So how does this affect my first thought?
How much do I believe my first thought now? %
What’s my new thought?
How much do I believe my new thought? %
What will I do differently in the future because of this?
17
Session 4 Notes
This Week:
Practise using behavioural experiments to put your thoughts to the test.
18
Square Breathing
Breathe in for 5 seconds and imagine the side of a square
being drawn...
Then hold your breath for 5 seconds as you ‘see’ the next
side of the square being completed...
Exhale for 5 seconds, watching the third side of the square
being drawn...
And, hold for 5 seconds, watching the full square take form.
Hold for 5
Breathe in for 5 Exhale for 5
Start
Hold for 5
While focusing on your breathing in these ways, you will find that
you are not worrying about other things.
Practice square breathing each day as part of your routine to feel
calmer, and to effectively use square breathing at times during the
day when you feel particularly anxious.
19
Progressive Muscle Relaxation (PMR)
As discussed in session 1, our bodies respond automatically
to stressful situations and thoughts by becoming tense.
This technique is about reducing the tension and adrenaline
in your body, which is also a good way of relaxing the mind.
The idea is to tense or squeeze each muscle in your body as
tightly as possible for up to 15 seconds, and then release
them and make them go limp.
This relaxes the muscles and allows you to notice the
contrast between tension and relaxation.
Preparation
Lie down flat on your back, on a firm bed, a sofa, or on the floor.
Support your head and neck with a pillow or cushion. Alternatively
sit in a comfortable chair with your head well-supported. Close your
eyes if you are comfortable doing so.
Sequence: Tense that body part, hold it for a few
moments, then relax...
1. Hands – clench your hands to make fists
2. Arms - raise both forearms and squeeze them against your
bicep muscles
3. Feet – make fists with your toes
4. Lower Legs – tense your calf muscles
5. Upper Legs – tense your buttocks
6. Shoulders – raise them up to touch your ears
7. Face – scrunch up the muscles in your face
20
Relapse Prevention
What makes me feel bad?
What are my warning signs?
What can I do that helps?
What barriers are in my way?
What have I achieved?
What do I have planned for the future?
21
Session 5 Notes
Final Session:
Practice square breathing and PMR each day as part of your routine to
become an expert in these relaxation techniques.
Complete the Relapse Prevention worksheet.
Consider and write down your goals for the future.
22
Need Further Support?
If you are concerned about your safety or
you do not feel able to keep yourself safe,
please contact one of the following for
support:
• Contact a friend or family member
• Call Samaritans (24 hours) on 116 123
or e-mail
[email protected]• NHS out of hours support: 111 or 999 (in
the case of an emergency)
• Speak with your GP or other healthcare
professionals involved in your care
If you live in Southampton:
• The Lighthouse -
https://www.southernhealth.nhs.uk/locations/thelig
hthouse/
• Solent Mind – for peer support
If you live in Dorset:
• Call Connections, a local 24/7 helpline run by Dorset
HealthCare: 0300 123 5440
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