good book to treat with anixiety

1. DesigningaHealthActionPlan
Afteryou’ve lookedcarefullyatyourlifestyle andtakenintoaccountyour
geneticrisks,decide whatstepsyoucantake to improve yourchancesof
havinga long,healthylife.Don’ttryandtackle everythingatonce;at first,
justwrite downone or twosmall,achievable goals.The followingexamples
can guide you:
✓ If you’re inactive,don’tplanonrunningthe nextmarathon;startby
walking15 minutesaday, mostdaysa week.
✓ If youhave a familyhistoryof highcholesterol,getareferral toa dieticiantotalkaboutwaysto
improve yourdiet.
✓ Buy sunscreenandweariteveryday.Dailyuse of sunscreenhasthe
addedbenefitof keepingyourskinlookingyoung.
✓ Flossyourteeth;itdoesmore for your healththanyouthink!
✓ Keepontryingto quitsmoking.Itmay take lotsof effort,butmillionsof
people eventuallydoquit;youcantoo.
✓ Add one more servingof fruitsandvegetablestoyourdiet.
✓ Don’t putoff medical screeningtests — especiallymammogramsand
colonoscopies.
✓ If youdo getsick,be hopeful andoptimistic.
✓ Stay connectedwithfriendsandfamily.
✓ Acceptthe fact that life anddeathare part of this world.
Whenyou’ve accomplishedone ortwogoals,adda new one.Keepthe
processgoinguntil you’ve reallyimprovedyourhealth;youranxietywill
decrease asyour bodyfeelsbetter.
23_574416-ch16.indd 252 3/22/10 9:55 PM

2. Chapter17
KeepingOutof Danger
In ThisChapter
▶ Figuringouthowdangerousyourworldis
▶ Stayingassafe as you can
▶ Dealingwithscaryevents
▶ Lettinggoof worries
Unexpectedeventsfrightenmostpeople fromtime totime.Have youever
beeninan airplane whenturbulence causedasuddendipof the plane
as well asyour stomach?Or watchedinslow motionasanothercar careened
across the road slidinginyourdirection?How aboutnoticingsomeone wearing
dark clothing,who’snervouslyglancingaround,sweating,andcarryingalarge
bag at a ticketcounter?Doyou geta bit jumpyina strange cityin the dark, not
sure whichwayto go, withno one around,whena groupof quietyoungmen
suddenlyappearonthe corner?Boo.Sorry if we scared you.
Thischapter isabouttrue feelingsof starkterrorand the emotional aftermath of beingterrified.First,
we take a lookat yourpersonal risks — justhow
safe youare and howyoucan improve yourodds.Thenwe discussmethods
youcan use to prepare orhelpyourself inthe eventthatsomethingterrifying
happenstoyou.Finally,we talkaboutacceptance,apath to calmnessand
serenityinthe face of an uncertainworld.
EvaluatingYourActual,Personal Risks
Chapter15 discussesthe factthat the riskof experiencingnatural disasters
isquite lowformost people.Butlotsof people worryaboutthemnonetheless.Interestingly,the same
can be saidaboutrisksof terrorism.Billionsof
dollarsare justifiablyspentbattlingterroristactivities,andaccordingtoa

3. 2005 reportin GlobalizationandHealth,you’re 5,700 timesmore likely todie
fromtobacco use than an attack of terrorism.Similarly,the journal Injury
Preventionnotedin2005 that you’re 390 timesmore likelytodie froma motor
vehicle accidentthanfromterrorism.
24_574416-ch17.indd 253 3/22/10 9:55 PM
254 Part IV:ZeroinginonSpecificWorries
However,yourriskof exposure tosome type of nonlethal,violentevent
ismuch greater.For example,around3 million(about1percent) of all
Americanswill be involvedinaseriousmotorvehicle accidentinanygiven
year.Andabout 1.4 million(slightlylessthanahalf a percent) of the people
of the UnitedStatesalone will fallvictimtosome type of violentcrime.
For those whosignup to serve andprotectour countrythroughthe military,
the riskof injuryincombat variesgreatlyovertime andalsodependsonthe
particularwar. However,forsomeoneinacombat zone,the riskof death
palesincomparisontothe chances that the personwill experienceserious
injuryor witnessactsof severe violencetoothers — and thenstruggle emotionallyafterward.
Anyexposure toviolence,includingjustwitnessingit,posesamajorrisk
factor fordevelopingwhat’sknownaspost-traumaticstressdisorder(PTSD).
PTSD isa serioustype of anxietydisorderthatoftenfollowsexposure toone
or more traumatic events.People findthemselveshavingintrusive images
of the event(s) andoftenworkhardtoavoidremindersof it.Theyalsofrequentlylosesleep,become
easilystartled,andexperience increasedirritability(see Chapters2 and8 for more informationabout
PTSD).The following
sectionreviewswhatyoucan doto reduce your risksof experiencingtrauma.
MaximizingYourPreparedness
No matterwhatyour risksforexperiencingviolence,we advise takingreasonableprecautionsto keep
yourself safe.A littlepreparationusuallydoesn’t

4. cost a lot intermsof eithertime ormoney.The keyismakingactive decisionsaboutwhatseems
reasonable andthentryingtoletyourworry go
because you’ve done whatmakessense.If,instead,youlistentothe anxious,
obsessionalpartof your mind,you’ll neverstopspendingtime preparing —
and needlesslyupsetyourlifeinthe process.
Takingcharge of personal safety
Chapter15 listsimportantpreparatorystepsyoucantake in possible anticipationof natural disasters.
Those same itemsapplytobeingpreparedforterrorismandotherviolentsituations.Inaddition,we
recommendyouconsidera
fewmore actions:
✓ Alwayshave astash of cash on hand.
✓ Have extraprescriptionmedicationforimportantmedical conditions.
✓ Have a store of critical supplies,suchastissuesandtoiletpaper.
✓ Have a multi-tool thatcanfunctionasa screwdriver,canopener,knife,
and so on.
24_574416-ch17.indd 254 3/22/10 9:55 PM
Chapter17: KeepingOutof Danger255
✓ Have some ducttape andplasticsheeting.Ducttape can fix a lotof
thingsina pinchand alsoserve to preventwindowsfromshattering.
Plasticsheetingcanbe usedtoseal out toxicplumes.
✓ Have painters’ masksforeveryone toreduce exposuretosmoke and
fumes.
Alwayskeepatleasta three-daysupplyof foodandwaterforeachhousehold
member.
Avoidingunnecessaryrisks
The bestway to minimize yourriskof experiencingorwitnessingviolence is

5. to avoidtakingunnecessaryrisks.Of course,regardlessof whatyoudo,you
can’t protectyourself fromlife.People don’tasktobe victimsof crime,terrorism, oraccidents,andyou
can’t preventsucheventsfromeveroccurring.
But youdon’thave to ask for trouble either.We suggestthe following,fully
realizingthatsome of these maysounda little obvious.Butbecause people
oftendon’tfollowthesesuggestions,here theyare:
✓ Wear seatbelts;needwe saymore?
✓ Hold ontopursesor bags tightlywhenwalkingincrowdedareas.
✓ If youhave a wallet,carryitinyour frontpocket.
✓ If you’re traveling,researchthe areaforknownrisks.The U.S. State
Departmentlistsareasdeemedunsafe fortravel becauseof terrorismor
otherknownrisksat http://travel.state.gov.
✓ Make copiesof your passport;give one tosomeone before youleave,
and putanotherin yourluggage separate fromthe bag youcarry.
✓ Don’t wearexpensive jewelrywhenyoutravel.
✓ Don’t drive interrible weatherconditions.
✓ Considercarryinga loudwhistle inyourpurse orpocket.
✓ Heedthe oft-givenadvice toreportanyunattendedbaggage inairports,
trainstations,or hotel lobbies.
✓ If you’re ina hotel room,don’tanswerthe doorunlessyouknow whoit
is.If you’re notsure,call the frontdesk.
✓ If youdo have to walkinan unsafe area,walkquicklyandpayattention.
✓ Have yourkeysout andreadyas youapproach yourcar, and lookbefore
youget in.
✓ Try notto walkalone indark,secludedareas.

6. 24_574416-ch17.indd 255 3/22/10 9:55 PM
256 Part IV:ZeroinginonSpecificWorries
Finally,don’tlimityourabilitytoenjoylife.Realize some risksare inevitable.
Considertravel toplacesotherthanyourbackyard! Getto know some people
fromotherculturesand lands.See some interestinglandscapes.Inother
words,don’twall yourself off fromthe world.
DealingwithTrauma
We hope you’re neveravictimof nor a witnesstosevere violence,butwe
knowit’sa real possibility.Violence occursinwar, on the streets,andevenin
the workplace.Soif you’ve recentlybeenavictim, youmaybe experiencing
some serioussignsof anxietyordistress.Thatreactionisprettynormal.And
the firstthingwe’re goingtotell youisthat, unlessyoursymptomsare quite
severe andinterferinggreatlywithyourlife,don’tseekoutmental-health
treatmentrightaway!That’sbecause,inmanycases,your mind’sownnatural healingprocesswill
suffice.
Furthermore,it’squite easytointerfere withnatural recovery. Forexample,a
single debriefingsessionoftentakesplace afterexposuretoa traumaticevent.
In sucha session,people are givenbasicinformationabouttraumaandits
potential effectsandare thenencouragedtotalkabouthow they’re coping
withit.But such a sessionmayactuallyincrease the riskof emotionalsymptomsoccurringorcontinuing.
If you’re offeredsuchasingle-sessionintervention,we suggestskippingitunlessit’sobligatory.It’s
perfectlyokaynotto
wantto talk aboutthe trauma right away.
So here’swhatwe recommendyoudofirstif you’re unfortunate enoughto
witnessorexperience ahighlytraumaticevent:
✓ Realize thatit’snormal to feel fearful anddistressed.
✓ Talk to people youfeelcomfortable discussingthe traumawith,but

7. don’tletyourself be pressuredtotalkbyanyone.
✓ Ask yourself whatyou’vedone inthe pasttoget throughtoughtimes,
and see whetherthathelpsyougetthroughthisone.For example,some
people findbenefitfromspiritual counseling,prayer,turningtofriends,
or increasingexercise.
✓ If you’re experiencingsevere symptomssuchasflashbacks,serious
insomnia,significantirritability,oranxietyafterafew months(even
soonerif the symptomsare highlydisturbing),considerseeingamentalhealthprofessional forthree or
more sessions.Be sure toask if your
therapistusesevidence-basedtreatment(thatis,supportedbyscientific
research) forPTSD (see Chapters2and 8 formore informationabout
PTSD).
24_574416-ch17.indd 256 3/22/10 9:55 PM
Chapter17: KeepingOutof Danger257
In workingonthe ideaswe discussinthe followingsections,we stronglyrecommendthatyoudoso in
collaborationwithalicensedmental-healthprofessional whohasexperience treatingPTSD.
Thinkingthroughwhathappened
Whenpeople have beenexposedtotrauma,the experience nevergoesaway.
In otherwords,youcan’t evercompletelyerase the experience fromyour
mind.Butwithhelp,the miseryandpaincan decrease,andlife satisfaction
can get muchbetter.
Cognitive processingtherapy(CPT)wasdevelopedbyPatriciaResickand
colleaguesandhasbeenshowntohelpsome survivorsgettoa betterplace.
Withthisapproach, youtake a hard look backand write a statementabout
the meaningthatthe traumatic eventhadforyou inyour life.Inotherwords,
describe howyouthinkyourlife haschanged:

8. ✓ Do you feel responsible forthe trauma?
✓ Do you feel unsafe everywhere yougo?
✓ Have youchangedthe way youfeel aboutyourself asaperson?
✓ Are youangry,sad, or ashamed?
Your therapistwill thenhelpyouexplore yourfeelingsandhow your
thoughtsmaybe contributingtomakingthingsworse thantheyneedtobe
for you.Amongotherthings,yourtherapistmayaskyou these questions:
✓ How doesthiseventaffectthe wayyousee yourself andthe world?
✓ What wouldyoutell a friendthatthiseventmeantabouthimorher as a
person?Canyou acceptsayingthe same thingto yourself?
✓ Do you knowanyone whohascopedwithsomethinglikethis?If so,how
didtheydo it?
✓ Do you believe thatyou’re more unsafe thananyone else?If so,whatis
the evidence thatyouare?
✓ Did youwant thistraumaticeventtohappento you?If not, can youstop
blamingyourself?
✓ Is there anythingshamefulabouthavingbeenavictimof traumaor
violence?
✓ Can you thinkof a creative newpossibilitythatcouldresultfromthis
challenge?Forexample,couldyouvolunteertohelpothersinsimilar
situations?
24_574416-ch17.indd 257 3/22/10 9:55 PM
258 Part IV:ZeroinginonSpecificWorries
Finally,yourtherapistislikelytoaskyouto write aboutthe actual traumatic
eventingreatdetail.Thenyou’ll probablybe askedtoreadthat storyout

9. loudto yourself everysingledayfora periodof time.Asyoudo,don’ttry to
squelchyouremotions;instead,letthe feelingsflow.Youcanalsoembellish
your storywithmore detail overtime.
Some professionalsconsiderthiswrittenaccountandthe readingof the
traumaticeventtobe a form of exposure therapy.Preliminaryevidence
suggeststhatthispart of CPT maywork as well asexposure,whichwe discussinthe nextsection.
However,repeatedlyreadingyourwrittenaccount
of the eventmaybe somewhatlessdistressingthanmore directexposure
strategies.
Exposingyourselftothe incident
Exposure therapy,aswe describe inChapter8,has beensupportedbymore
researchstudiesthananyotherapproach fortreatingPTSD.Briefly,exposure
therapyinvolves makingextendedcontactwiththe traumaticevent,usually
throughimagery.Forexample,acombatveteranmaybe askedto make an
extensive listof all the detailsof histraumaticcombatexperiences.He would
thenbe askedto listeachdetail andrate itfor how much distressitcauses
himwhenhe thinksaboutit.
The listis organizedintoahierarchy,orwhat we call a staircase of fear.
Startingwiththe leastupsettingstep,he wouldbe askedtoimagineitin
detail until hisanxietyanddistressdropsignificantly.Thenhe wouldmove
on to the nextstep.See Chapter8 fordetailsanda specificexample applied
to PTSD.
The main problemwiththisapproachliesinthe factthat lotsof trauma victimsreallydon’twantto
revisittheirtrauma.Thus,the veryideaof therapy
elicitsfeelingsof greatdistress.Forsome,exposure seemslike addingmore
sufferingtotheiralreadytraumatizedlives.Forthatreason,amongothers,

10. far too manytrauma victimsfail togettreatment.
If youfindthat the prospect of exposure therapyseemscompletely
overwhelmingtoyou,considerseekingCPTfirst.Noteverymental-health
professionalhasbeentrainedinbothexposure therapyandCPT,sobe sure
to ask.
AcceptingaCertainDegree of Uncertainty
Emotional distressstemmingfromtraumasandviolence presentsachallenge,yetit’squite normal.It’s
importantto realize thatpeoplecan’tcontrol
the emotionsthatarise fromsuch causes.The more youcan acceptthat fact,
24_574416-ch17.indd 258 3/22/10 9:55 PM
Chapter17: KeepingOutof Danger259
the more easilyyou’ll be able tocope withlife andwhateveritdealsyou.The
nexttwosectionstake a lookat acceptinguncertaintyandrisk.
Choosingtoput yourself
inhigh-risksituations
Some people,like police officers,emergencymedical personnel,soldiers,and
firefighters,choose toexpose themselvestothe bestandworstof life.Their
motivesare positive:Theymayhave a strongdesire tohelpothers,feel a
deepsense of patriotism, orwanttomake a positive difference inthe world.
These people oftenbecome traumatizedbythe horribleeventsanddisasters
that theymustdeal with.Anda goodpercentage of themendupwithsymptomsor a diagnosisof PTSD.
Those whofullyunderstandandacceptboththe risksof the joband the
fact that theymayexperienceemotional distressfromexposure totrauma
justmay be a little lessvulnerabletotraumaticeventsthanthose whosee
themselvesasinvincible.Paradoxically,the more youcanaccept whatever
responsesyouhave,the more easilyyou’llprobablydeal withthem.

11. However,those whoview themselvesasindestructible mayactuallychoose
to go intotheirfieldswithaninflatedsenseof invulnerability.These people
are more likelytohave emotional painfromtheirexperiencesandrefuse or
shunhelp.Theybelieve thatpartof theirjobis to handle whateverhappens
to them.Sadly,they’re notimmune tohorrorandtrauma, yettheythinkthat
theyshouldbe.
If youor someone youcare about has a front-linepositioninafieldlikemedical care,law enforcement,
or the military,you’re atrisk,justlike everyone
else,forgettingastressdisorderfromexposure tohorribleevents.This
doesn’tmake youweakor lesscompetent.Youmustbravelyface youremotional pain andgethelp.
Denyingthe emotionalpaindullsyourabilitytocontinue tohelpothers.
Experiencingdangerineverydayplaces
A lotof people live livesinwhichtheytrytostay awayfromdanger.But life
happenstothemas well.People are exposedtoviolence inplacesthatwere
once consideredsafe:schools,churches,synagogues,mosques,parks,and
the workplace.Uncertaintyinthisworldiscertain.
24_574416-ch17.indd 259 3/22/10 9:55 PM
260 Part IV:ZeroinginonSpecificWorries
The onlyalternative toacceptance of riskand uncertaintyistodevote your
entire life toanticipatingandavoidingrisk.The problemhere isthatyour
effortswill still fail you.Evenif youspendeverywakingmomenttryingto
avoidrisk,itwon’twork.So far we know of no one who hasmanagedto avoid
the ultimate riskof death.
The followingstoryillustratestypical symptomsof PTSDfollowingamotor
vehicle accident,whichisbyfarthe mostcommonavenue togettingPTSDin
mostparts of the world.

12. Lewhad always assumed,like mostpeopledo,thata greenlightsignals
it’ssafe to proceedthroughanintersection.He haddrivenwiththat
assumptionfor20 yearswithoutmishap.One dayonthe wayto work,
Lewdrivesthroughan intersectionthathe hassafelytraversedhundredsof timesbefore.Suddenly,an
SUV barrelsthroughthe redlightand
broadsidesLew’ssedan.Lewsuffersseriousinjuries.Afterseveral weeks
inthe hospital,he spendsmonthsinrehabilitation.
WhenLewreturnsto driving,he findshimself creepingthroughintersectionswithintensefeelingsof
anxiety.He canbarelymake himself drive
to workand back each dayand avoidsdrivingwheneverpossible.He
frequentlyvisualizesthe accident,althoughhe triesveryhardnotto.His
bodyacheswithtension.He wakesupinthe middle of the nightbefore
he has to drive andcan’t go back to sleep.He’sirritableandmoody.
Lew’sdoctortellshimthathe nowhas highbloodpressure andthat
he needstoreduce hisstress.Lewworriesabouthisworrybut doesn’t
knowwhathe can do aboutit.He thinkshe may have to take a leave
of absence fromwork.Hissupervisorislosingpatience withhim.
Desperate,Lewmakesanotherappointmentwithhisdoctor.Thistime,
the doctor takestime to askLew abouthissymptoms.He refersLew toa
psychotherapistwhospecializesinworkingwithpeoplewithPTSD.
The therapistrecommendsexposuretherapy(seethe earliersection
“Exposingyourself tothe incident”) involvingaseriesof stepsthatstart
withtalkingaboutthe accidentandgraduallyincrease indifficultyupto
repeatedlydrivingthroughbusyintersections.However,Lew can’tget
past the firstcouple of steps.He berateshimselfforfailingtoprogress.
NowLewfeelsanger,notonlyabouthisaccidentbutalso toward himself.

13. The therapistbacksup and workson acceptance.He helpsLew tosee
that feelingsare justfeelings,notsomethingtobe avoided.He teaches
Lewhow to remainincontactwithhisemotionswithoutjudgingthem.
Lewgraduallylearnsto accept hisemotionsforwhattheyare.Thenthe
therapistworksonCPT (see the section“Thinkingthroughwhathappened”),andLew makesexcellent
progress.
24_574416-ch17.indd 260 3/22/10 9:55 PM
Chapter17: KeepingOutof Danger261
Unusual,unpredictableendings
Consideraskingyourself howyoucouldavoid