A Stepped Guide to Developing Trina's MAP

Meet Trina:

Trina is a 28-year-old accountant who recently started her first job after graduating with good marks and high-performance evaluations. She lives with her two cats and her best friend. Trina has always been an anxious person. She describes herself as a "worry wart," and her friends and family often tell her she worries too much. Although this has been a longstanding problem, it has been particularly bad over the past year as she has transitioned to this new job. Currently, she worries about whether her boyfriend will leave her, the health of her cats, her work performance, what her coworkers think of her, her weight, and having enough time in the day to get everything done. She has great difficulty controlling these worries, and they often intrude when she is trying to relax alone at the end of each day, during down time at work, and when out with friends. In addition, she feels exhausted and has constant muscle tension and body aches, as well as trouble sleeping most nights. She has recently been assessed and diagnosed with Generalized Anxiety Disorder, and possible Social Anxiety Disorder. For more information about Trina click here.  

Introduction

To provide you with an example of how a typical My Anxiety Plan (MAP) might look, we have created a MAP for Trina, a fictional 28-year-old female with generalized anxiety disorder described above. The following information outlines session to session material highlighting how you can engage with the MAP material to learn about anxiety, and become skilled in using a range of effective tools and worksheets on this website. As a result, you will be able to create a complete and comprehensive MAP personalized to your specific needs and learning style.

Session 1    

Topic: Learning about how anxiety affects me

Tools:

Example Worksheets:

  • None

In some ways, I felt as though I already knew this information, from reading things on the internet and talking with friends and coworkers. However, taking the time to read and reflect on the information, was quite useful to help me keep the facts in my mind as a first step to stopping worry from taking over.

Session 2    

Topic: The science of anxiety

Tools:

Example Worksheets:

The material in Session 1 & 2 really surprised me. I had no idea other people also struggle with some of the same things I do, and that anxiety can be such a problem. I realize just how much it is affecting my life and that I do not need to continue to live this way- I feel hopeful that there is actually something I can do about my symptoms and experiences.

Session 3    

Topic: Getting ready: Setting the stage to fight back against unwanted anxiety

Tools:

After reviewing the many ideas in Session 3 I took a break for a few weeks to implement things. I figured that I’d like to proceed through the MAP materials slowly to really take advantage of all the ideas. I particularly liked the strategies on Getting a Good Night’s Sleep as this has been a longstanding problem for me, as well as material in Healthy Eating and Tips for Healthy Living. I also spoke with my roommate about what she can do (& stop doing!) to help me.

Example Worksheets:

  • My Team - I included a variety of people on my “team” as worry affects me in a variety of places. I figured it will help me to have some cheerleaders in all areas of my life.
  • Rewarding Bravery - I made a list of items from small to large that I can use to reward myself. I think I prefer to reward myself on a casual basis, when I need a boost, or when the challenges I face are particularly difficult.

Session 4    

Topic: Learning to relax

Tools:

Example Worksheets:

  • None

I’ve done yoga in the past and a mindfulness weekend retreat, so the relaxation tools were familiar to me. I am ready to make a commitment to start using them again. Also, I’ve downloaded the MindShift App on my i-pod so I can use the audio file to help me.

Session 5    

Topic: Relaxation (continued), and starting to build My Fear Ladder

Tools:

Example Worksheets:

Building My Fear Ladder was a little overwhelming and confusing. At first, I was not sure what to choose to “face,” as there are so many situations I could pick. However, after re-reading the material I realized I could pick a behaviour instead of a situation. Since my worry seems to follow me in all situations, finding just one would be hard, so I decided to pick my behaviour of checking or seeking reassurance from others. Also, it helped that the first step was just making the list- I did this over the weekend, and then ranked the list later in the week. It was a good idea to do this in two parts to help me feel less anxious about what lies ahead. I think for me spacing some of these sessions and their activities a few days-weeks apart is best for my type of learning style.

Session 6    

Topic: Finish building My Fear Ladder

Tools:

Example Worksheets:

Ranking the items on My Fear Ladder was not as hard as I first thought. As you can see I tried to make sure the gaps were not too large, as just like a real ladder, if the steps are spaced too far apart you cannot climb up! This meant I needed to add a few extra steps from when I made my first ladder.

Session 7    

Topic: Understanding brain messages and identifying thinking traps

Tools:

Example Worksheets:

Not all of these tools were relevant to my type of worry. I used the Worry Diary to record my worries over a few weeks to learn more about the themes or patterns to my worry. It was interesting to realize that although I spend a lot of time worrying, and thought I was an expert on my worry, I had no idea that worries can be classified into different types (current and hypothetical), or that the concept of a “trap” is important to recognize. I learned to “catch” these negative and unhelpful “brain messages” in action and record them. The Thinking Traps worksheet was then useful to help me understand that although I fall into many of them, I most often fall into the traps of: Catastrophizing, Over-estimating Danger, and Mindreading.

Session 8 & 9         

Topic: Changing the way you think

Tools:

I found the information in Helpful Thinking really useful to understand what I need to be doing with my unhelpful, fear messages. By using some of these tools, I have started to realize I have options and that simply worrying is not productive. Specifically, the Rethinking the Usefulness of Worry was really helpful to let me see that worry does not prepare me nor does it protect me from bad things. In fact, there are far more useful strategies to use to prepare and protect. I really liked the Cognitive Coping Cards idea, and made several post-it-note reminders to stick at my desk at work. I also stuck a few on my bathroom mirror to help remind and empower me in the morning as I get ready to go to work.  

Example Worksheets:

I found some of these really helpful. My favourites, which I have completed for you to see are Now or Later, and Helpful Thinking

Session 10  

Topic: Introduction to exposure therapy

Tools:

As in some of the previous sections where there was a lot of new information to learn, I took my time to review how exposure therapy works. I learned more about why certain of my coping strategies have been keeping me trapped. And finally, since I have identified wanting to reduce my dependence on checking, and designed a ladder in session 5 & 6, I’m feeling ready to start the exposure work.

Example Worksheets:

I decided to start with the easiest item on My Fear Ladder, which is leaving the house without asking my boyfriend Chris how he thinks I look. I planned out the 10 days which you can see on my “before” Facing Fears worksheet.

As you can see on my “after” Facing Fears worksheet, although I had ranked this challenge as a “1” on my ladder, when Monday arrived, I was more anxious than I expected. I think it might have been because I had a client meeting that morning, so how I looked was more important than on other mornings.  

Session 11-17+     

Topic: Continuing exposure and/or engaging in other helpful behavioural tools

Tools:

Once again, there are lots of useful tools in sessions 11-17. I took the time to talk to my parents, and people on my team about how they can be helping me. In particular, my parents have been so used to giving me reassurance over the years, it’s now second nature to them. So, it was important that I speak to them about just how important it is for them to make changes with this. In addition, after reading about Getting a Good Night’s Sleep in session 3, I have been making important changes with my sleep using the Sleep Diary. Finally, I also see how I have a tendency towards perfectionism, so I plan on making some changes with that. Perhaps that will become a future ladder.

Example Worksheets:

In week two I moved up on my ladder to begin taking small steps towards my eventual goal of leaving work on time. But I also included continuing to reduce unnecessary checking about my appearance by decreasing how many coworkers I check in with. I liked blending two items into one sheet as it felt manageable to handle two items and not just one. And, much to my surprise, as I got going things got easier. I even left work earlier than I planned on Tuesday and Wednesday because I felt I could. And by the end of my week I was down to checking in with only 1 coworker. I’m feeling really good about my progress!

I am making progress and as you can see with this week I had jumped up a few rungs as I worked hard last week, continuing on my goals of leaving work on time and less appearance checking. So this week I focused on actually leaving work on time, and making spontaneous plans without checking in with others.  

I had to skip a week of working on my exposure ladder as I got sick with a pretty bad cold. But since I had been working hard for almost six weeks, I figured it was okay. Plus I really didn’t have a choice- I could not go in to work or go out socially. This week I focused on starting to tolerate handing in my spread sheets without checking, and even starting to make small mistakes. It was a scary and hard week, but as you can see it got easier over time. I want to do another week of this exposure practice until it no longer bothers me much.

Session 18-19

Topic: Exposure: Special Topics OR continue exposure work

These tools were not relevant for me, although I read over the information outlined in the Effective Communication tool and found this helpful as I do get anxious in certain social situations. It gave me some useful strategies to try which has helped lower my anxiety at work and at parties.

Example Worksheets:

I’m almost done with this hierarchy. I feel really good about how far I have come. I never thought I could have done this a few months ago!

Tools:

Part 5

Session 20: Wrap Party

This session marks the last session of the MAP program, and gets you ready to finish wrap up your hard work.

Objectives: 

To design an exposure ladder to keep you engaged in exposures on a routine basis, also called living an exposure lifestyle. This can mean doing an exposure once every few days, or planning for a once-in-a-while exposure to prevent specific fears from creeping back in. In addition, you will create a Relapse Prevention plan that teaches the difference between a lapse and a relapse, and offers guidance on how to prevent anxiety from making a ‘come back.’ As well, this session is an opportunity to celebrate your hard work. Some individuals like to use this final session to have a small celebration to mark the occasion, such as going out to a restaurant, taking a day-trip somewhere meaningful, or doing a special activity together. 

Session 20

Topic: Creating an exposure lifestyle to maintain progress, and Wrapping up

Tools:

The most useful information for in this session is the relapse prevention material. I took the time to think ahead to the next year and what lies ahead, and I realize that there will be some pretty stressful events coming up. I’m thinking of these as my “red flags.” I have my sister’s wedding and an important job review. As well, my cat has been diagnosed with diabetes so I think as his health worsens it’s going to be hard on me. I also made a small “cheat sheet” with my top 5 favourite skills so I can keep using these. It took a full 24 weeks to do all my MAP work- there was one week I was sick, and then I took a week off for vacation. As well, there were a few sessions that I allowed 2 weeks for instead of the recommended 1. As a way to honor my efforts, Chris and I agreed to go away on a short weekend trip. We will celebrate my past 6 months of work in style!!

Example Worksheets:

I have made a new ladder that I will work on over the next few months. I feel really optimistic about my ability to do this ladder as I now have so many new tools. I no longer struggle with sleep at night, and am less irritable than I used to be. Chris feels that my hard work has paid off and I agree.