Knaus has hit the bull’s-eye! From a horde of scientific studies and his own extensive experience, he has distilled an accessible, easily assimilated, pragmatic, and schematic approach to dealing with “parasite” anxieties. Readers can work through this program in small bites to gradually advance their control over their destructive anxieties. —Joseph Gerstein, MD, FACP, Harvard Medical School In The Cognitive Behavioral Workbook for Anxiety, Knaus condenses cognitive and behavioral skills to combat parasitic fears and anxieties into a clear, orderly, and concise process. Read this book, work through its exercises, and save yourself from the abyss of needless pain and suffering. —Elliot D. Cohen, Ph.D., author of The New Rational Therapy This is a great book. It’s an extremely well-written guide to action for those suffering from various conditions from anxiety and depression to severe procrastination. But it’s far more than just another self-help book. Instead, this prescription for happiness and health is based on scientific evidence. Between these covers there is a complete course in psychology. I only wish my graduate psychology students had as much genuine knowledge of our field as is found in this book. —Richard Sprinthall, Ph.D., professor emeritus, American International College Today, fear and anxiety are almost as prevalent as the common cold. But we have to wait for a cold to run its course before we feel better. This well-written, detailed, and informative book offers immediate, practical, and tested strategies that we can apply to get results right away! —Sam Klarreich, Ph.D., C. Psych., author of Pressure Proofing and president of the Berkeley Centre for Effectiveness in Toronto, ON, Canada Every once in a while, a self-help book appears that is so reader- friendly and thorough that I feel compelled to insist that my patients acquire it. The Cognitive Behavioral Workbook for Anxiety is such a book. Its innovative and powerful strategies will reduce the suffering of many. I predict it will quickly become the standard in scientifically sound assistance for anxious and fearful individuals. —Barry Lubetkin, Ph.D., ABPP, director of the Institute for Behavior Therapy in New York, NY Knaus has written an engaging book filled with practical strategies for defeating anxiety based on sound scientific principles. I recommend it highly for the millions who are plagued by unnecessary, pleasure- robbing fears. —Joel Block, Ph.D., ABPP, assistant clinical professor of psychiatry at Einstein College of Medicine Knaus digs deep into his years of clinical experience to provide both practical and powerful ways to eliminate the fears and worries that compromise one’s quality of life. Each chapter is filled with useful ideas, tips, and strategies that move a person from anxiety to peace of mind. My hope as a practicing clinical psychologist and workshop leader is that those who want to substantially lessen their anxiety as well as those who want to increase their well-being will give themselves the gift of this book. —Russell Grieger, Ph.D., clinical psychologist, adjunct professor at the University of Virginia, and organizational consultant This book is solidly researched and based on proven helping methods. The analyses of cases clearly show how to break down problems and provide ways to develop alternate views and behaviors. Forms and exercises provide guides for readers to examine their concerns. The complex cases demonstrate how clients can increase their tolerance for negative emotions and use self-management techniques to develop self-control. Only a person with decades of clinical practice could write a book of this depth and quality. —Robert E. Arthur, professor emeritus of psychology at the University of Wisconsin—La Crosse Knaus uses the term “parasite” to describe the impact of fear on behavior to vividly illustrate how it directs our lives. The Cognitive Behavioral Workbook for Anxiety not only shows one “how to,” but, of equal importance, “why to” address one’s fears. Knaus’ emphasis on prevention is further reason why a copy of this book is a must for students and families. —George Elias, professor emeritus of psychology at Assumption College Anxiety is one of the most debilitating emotions that we have to deal with. It prevents us from having a better life in many areas and restricts us from reaching our full potential. In The Cognitive Behavioral Workbook for Anxiety, one of the field’s most rational and insightful minds takes readers on a journey of discovery into the heart of anxiety and shows how to largely eliminate this emotional plague from our lives. —Vincent E. Parr, Ph.D., president of the Center for Rational Living in Tampa, FL Publisher’s Note This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional services. If expert assistance or counseling is needed, the services of a competent professional should be sought. Distributed in Canada by Raincoast Books Copyright © 2008 by Bill Knaus New Harbinger Publications, Inc. 5674 Shattuck Avenue Oakland, CA 94609 www.newharbinger.com Cover design by Amy Shoup Text design by Tracy Carlson Acquired by Jess O’Brien Edited by Brady Kahn All rights reserved Epub ISBN: 978-1-60882-063-4 The Library of Congress has cataloged the print edition as: Knaus, William J. The cognitive behavioral workbook for anxiety : a step-by-step program / William J. Knaus. p. cm. ISBN-13: 978-1-57224-572-3 (pbk. : alk. paper) ISBN-10: 1-57224-572-7 (pbk. : alk. paper) 1. Anxiety. 2. Rational emotive behavior therapy. 3. Cognitive therapy. I. Title. RC531.K63 2008 616.85’2206--dc22 2008029812 Contents Foreword Acknowledgments INTRODUCTION PART I DEFEATING FEAR THROUGH UNDERSTANDING 1. WELCOME TO THE WORLD OF PARASITIC ANXIETIES AND FEARS 2. DEVELOPING YOUR SELF-OBSERVANT SKILLS 3. OVERCOMING DOUBLE TROUBLES 4. SELF-MANAGEMENT TECHNIQUES TO DEFEAT FEAR 5. A MULTIMODAL ATTACK AGAINST ANXIETIES AND FEAR 6. FIVE STEPS FOR POSITIVE CHANGE PART II INTENSIFYING YOUR CAMPAIGN AGAINST FEAR 7. DEVELOPING THE MIND TO STOP ANXIETY 8. BUILDING EMOTIONAL TOLERANCE 9. BEHAVIORAL METHODS TO QUELL FEAR 10. BREAKING THE PROCRASTINATION-FEAR CONNECTION 11. OVERCOMING MIXED ANXIETY AND DEPRESSION 12. DEFUSING WORRY 13. STOPPING PERFECTIONIST THINKING 14. DEFEATING INHIBITION 15. ADDRESSING SELF-WORTH FEARS 16. ADDRESSING SOCIAL-EVALUATION ANXIETIES 17. VANQUISHING PANIC 18. PREVENTING ANXIETIES AND FEARS FROM COMING BACK Suggested Reading References Foreword Worry gives a small thing a big shadow. —Swedish proverb My grandparents, who emigrated directly from Sweden, had many sayings (like the one above) that I learned as a child. Most of these sayings did not have much meaning for me until later in life. Much of our learning occurs in this fashion from our families and cultures. This is the type of learning that seems second nature, the kind that seems invisible because we don’t even know how or what we know. Many positive as well as negative habits are transferred to us through this transgenerational learning. Some learnings help us to cope with life while others tend to be destructive and include fears, anxieties, worries, and phobias. Alfred Adler explained that fears, anxieties, worries, and phobias have a function or purpose. Anxiety is a safeguarding mechanism that causes people to frighten themselves out of doing things. They could simply decide not to do these things, but then they might have to face their complexes and admit them. With anxiety as a mechanism, they claim they are too afraid to try (Carlson, Watts, and Maniacci 2006). These patterns are frequently acquired without our direct awareness or conscious intent. It has been reported that anxiety impacts one-third of the population at one time or another. In researching this topic, I found that Google had over nearly 60 million entries for anxiety alone. The various listings described the many strategies purported to provide relief for anxious mood. These ranged from various drugs to biblicalpassages to diets to folk cures. This book is different in that it has strategies that have been researched and proven to be effective. They do not promise a quick fix but, rather, teach us how to take responsibility for our own lives. Too many people blame others for their personal challenges. As Bill Knaus states, “Blame, like the air, is everywhere.” This book provides three basic prescriptions to help conquer the problem of anxiety: 1. Educate your reason to oppose parasiticthinking and reacting. (Change your thoughts.) 2. Learn to build emotional tolerance. (Strengthen your emotions.) 3. Behaviorally engage the fear and desensitize yourself to it. (Take action.) These interventions integrate thinking, feeling, and acting modalities. This allows individuals to utilize their strengths and preferences. I have had the good fortune to travel to many different cultures. In my work with indigenous people, I learned that it is not possible to feel anxious while breathing abdominally. This is often the best first step, as it not only provides relief from anxiety but also increases awareness. The quickest way to clear anxiety out of your body is to take a few deep belly breaths. Chest breathing seems to be wired into anxiety production, while belly breathing is connected to anxiety reduction. If you are anxious, you can wait until you are not anxious and your breathing will slow down. But if you are in a hurry to clear out the anxiety, you can slow down your breath consciously and watch the anxiety go away. By concentrating on our breathing, we can learn to accept the fact of fear, learn to feel fear fully, and act so that fear does not interfere with life choices. As David Riccio (2008, 21–22.) states, “We all feel afraid sometimes. This is an appropriate feeling and can be a signal of real danger and threat. At the same time, we sometimes feel afraid without reason. Our guesses and fantasies about what might happen keep us afraid of events and experiences that may never befall us. It is useless to attempt to eliminate fear altogether, whether it be ritualistic or imagined.” This book provides an impressive collection of techniques that can be used to provide the courage necessary to face anxieties and fears. All of the strategies have their roots in the work of the great psychologists Alfred Adler, Aaron Beck, Albert Ellis, and Arnold Lazarus and have withstood the test of time. They can be used to help change transgenerational learning patterns by developing courage and self-control. As I read through this exceptional resource book, I was reminded of the power of the mind. Bill Knaus has clearly presented many effective strategies that will allow readers to solve their own problems. This type of solution will lead to greater psychological hardiness and self-efficacy of the population. It is now possible to go beyond the many self-imposed prisons that we place ourselves within. Eleanor Roosevelt perhaps said it best: “You must do the things you think you cannot do.” —Jon Carlson, Psy.D., Ed.D., ABPP Distinguished Professor Division of Psychology and Counseling Governors State University I want to thank my wife, Nancy, for her review and comments on the manuscript, and my friend Ed Garcia for his many thoughtful contributions to the book. I also want to thank the following people for commenting on or contributing ideas to specific chapters: Gayle Rosellini, David Cowles, Bob Forester, Rina Cohan, Will Ross, Diana Nadeau, George Morelli, and Michael Edelstein. Last, but certainly not least, thanks goes to my copyeditor, Brady Kahn, for helping to improve the clarity of this book. This book is the first in a tribute book series to honor Dr. Albert Ellis, the founder of rational emotive behavior therapy. It is dedicated in his memory and in acknowledgment of his enormous contribution to the field of psychotherapy as the grandfather of the currently popular cognitive behavioral therapy methods. General editors for the series are Dr. Bill Knaus, Dr. Elliot Cohen, and Dr. Jon Carlson.