Exercises — Chapter 32: Anxiety, Depression, and the Spectrum of Distress

Part A: Understanding the Spectrum

Exercise 1 — Where Are You on the Spectrum?

This exercise is not a diagnostic tool. It is a self-assessment for personal reflection.

Using a 0–10 scale (0 = not at all, 10 = extremely), rate each of the following over the past two weeks:

Anxiety dimension: - How often have you experienced excessive or difficult-to-control worry? ___ - How intensely have you experienced physical tension (muscle tightness, headaches, stomach disturbance)? ___ - How often has anticipatory anxiety led you to avoid something you would otherwise have done? ___ - How much has worry about things going wrong interfered with your sleep? ___ - How much has fear of social judgment affected your behavior in social situations? ___

Depression dimension: - How much difficulty have you had experiencing pleasure in activities you normally enjoy? ___ - How often have you felt persistently low, empty, or hopeless? ___ - How much has fatigue or low energy affected your daily functioning? ___ - How frequently have you withdrawn from social engagement? ___ - How often have negative thoughts about yourself, the world, or the future dominated your thinking? ___

Anxiety subtotal: ___ / 50 Depression subtotal: ___ / 50

Reflection: 1. Was the balance what you expected, or did one dimension surprise you? 2. Looking at the individual items with your highest scores: are these recent developments, or ongoing patterns? 3. Using the chapter's concepts of intensity, duration, and interference — does your current level meet any of these dimensions?

Exercise 2 — Tracing the Spectrum in Your Own History

Think about three distinct periods in your life — at different ages or in different circumstances — and characterize your anxiety and depression levels in each:

Analysis: What patterns do you notice? Are there specific circumstances, life demands, or relationship configurations that reliably increase or decrease your distress level?

Part B: Anxiety Mechanisms

Exercise 3 — Identifying Your Anxiety Maintenance Loop

Choose one area where anxiety is currently active in your life (a situation you avoid, a recurring worry, a social context that produces distress). Map it through the maintenance framework:

The situation or trigger: ___

Avoidance behaviors (things you do to avoid the situation or reduce anxiety in it): 1. __ 2. __ 3. ___

Safety behaviors (things you do within the situation to prevent the feared outcome): 1. __ 2. __

The feared outcome (what you believe will happen if you drop the avoidance/safety behaviors): ___

Evidence for this outcome (has it actually happened? How often?): ___

Evidence against (times you've engaged without the feared outcome occurring): ___

The maintenance loop: Describe in 2–3 sentences how avoidance and safety behaviors are preventing you from discovering that the feared outcome is less probable than it feels.

Exercise 4 — The Anxiety Cognitive Profile

The chapter describes four cognitive patterns that maintain anxiety: probability overestimation, severity overestimation, coping underestimation, and attention bias toward threat.

For a current anxiety-producing situation, complete the following:

Probability estimation: - What is the feared outcome? - What probability do you actually assign to it? (0–100%): ___ - What would a neutral observer estimate the probability as? - What is the base rate for this kind of outcome actually occurring (what data exists)?

Severity estimation: - If the feared outcome occurred, how bad would it be on a 0–10 scale? ___ - How long would the impact last? - Have you experienced something similar before? What was the actual severity and duration of impact?

Coping estimation: - On a 0–10 scale, how confident are you that you could cope if the feared outcome occurred? ___ - What resources, skills, and support would you have available? - Have you coped with comparable difficulties before?

Revised assessment: After completing this analysis, write a single sentence that represents a more calibrated assessment of the situation, incorporating your revised probability, severity, and coping estimates.

Exercise 5 — Designing a Small Exposure

Exposure is the most effective behavioral intervention for anxiety. This exercise is not about dramatic confrontation — it is about identifying one small, manageable step toward a feared or avoided situation.

The avoided situation or domain: ___

The avoidance hierarchy (list from least to most anxiety-provoking): 1. (least) __ 2. __ 3. __ 4. __ 5. (most) ___

The starting point: Which item on the hierarchy would produce anxiety you could tolerate — not zero anxiety, but manageable? ___

The plan: When will you do this? Where? For how long? Without what safety behaviors?

The prediction: Rate your anticipated anxiety at the peak (0–10): ___ The outcome measure: After the exposure, rate your actual anxiety at the peak, and how long it took to reduce: ___

The data: Was the feared outcome less probable, less severe, and your coping more effective than you predicted?

Part C: Depression Mechanisms

Exercise 6 — Activity Monitoring

One of the most powerful insights from behavioral activation is that activities and mood are correlated — not perfectly, but reliably. Most depressed people don't know which activities help, because the depression's flatness makes everything seem equally grey.

For the next five days, track:

After five days, review the data: 1. Which activities reliably produce even small increases in mood? 2. Which produce the highest mastery ratings? The highest pleasure ratings? 3. Are there activities you're currently avoiding that historically produced better mood?

Exercise 7 — Behavioral Activation Planning

Using your monitoring data from Exercise 6 (or your general knowledge of which activities tend to help), design a behavioral activation schedule for the coming week.

The criteria for selecting activities: - Produces mastery (sense of accomplishment) OR pleasure, OR both - Is specific and scheduled (not "exercise sometime" but "30-minute walk, Tuesday 7 AM") - Is realistic given your current capacity (depression lowers capacity; start modestly) - Is distributed throughout the day and week, not clustered

Critical reminder: The goal is NOT to feel motivated before doing the activity. The goal is to do the activity regardless of motivation and to observe what happens to mood after. Motivation follows action in depression; it does not precede it.

Exercise 8 — Examining the Negative Cognitive Triad

Beck's negative cognitive triad — characteristically negative views of self, world, and future — maintains depression through automatic thought patterns. This exercise examines the evidence.

Choose one domain where the negative cognitive triad is most active for you (work, relationships, self-worth, the future).

Negative self view: Write the automatic thought as it actually appears:

"___"

Evidence that supports this view:

Evidence against this view (specific examples, counterinstances, alternative explanations):

Negative world view: Write the automatic thought:

"___"

Evidence for:

Evidence against:

Negative future view: Write the automatic thought:

"___"

Evidence for:

Evidence against:

The alternative: For each, write a balanced statement that incorporates the full evidence set — not a positive reframe, but an accurate one.

Part D: Cognitive Patterns

Exercise 9 — Identifying Your Cognitive Distortions

From the chapter's list (all-or-nothing thinking, overgeneralization, mental filter, disqualifying the positive, catastrophizing, personalization, emotional reasoning, should statements), identify the two or three that appear most frequently in your own thinking.

For each: 1. Name the distortion 2. Give a specific recent example of a thought that reflects it 3. Identify the emotional consequence of the distortion 4. Write a more accurate alternative

Exercise 10 — Defusion Practice

ACT's cognitive defusion is distinct from cognitive restructuring: rather than challenging the content of thoughts, it changes the relationship to thoughts. The goal is to notice thoughts as mental events, not facts.

Defusion techniques to practice:

Labeling: Instead of "I'm a failure," try: "I'm having the thought that I'm a failure." Notice the shift in relationship to the content.

The mind-commentary exercise: When your mind is making negative commentary, try narrating it: "There goes my mind, doing the failure prediction thing again." Observe without engaging.

Leaves on a stream: Spend 5 minutes imagining sitting by a stream. When a thought arises, place it on a leaf and watch it float by. Do not try to stop the thoughts; simply observe them passing.

After practicing one or more of these for a week: 1. Which technique produced the most useful shift in your relationship to difficult thoughts? 2. What made it useful — or what made it difficult? 3. How does defusion differ from "positive thinking"? Why might it be more effective for chronic negative thought patterns?

Exercise 11 — Rumination vs. Reflection

Rumination and constructive reflection look similar from the outside but have very different functions and outcomes. Rumination is repetitive, passive, focused on causes and consequences of distress, without leading to new insight or resolution. Reflection is purposeful, time-limited, and oriented toward understanding or problem-solving.

Identify a topic you currently ruminate about:

Rumination markers: (check if applicable) - □ You've thought about this many times without new conclusions - □ The thinking increases distress rather than reducing it - □ You return to the same themes repeatedly - □ The thinking has no clear endpoint - □ You feel worse, not better, after extended thinking about it

Converting to reflection: 1. What is the actual question you're trying to answer? 2. What would constitute a satisfactory resolution or response to that question? 3. Set a time limit: 15 minutes of deliberate reflection on this question, then disengage. 4. After 15 minutes: What did you conclude? What action (if any) does the reflection suggest?

The key skill: when the same loop starts again after the 15 minutes, recognize it as rumination and apply a disengagement strategy (physical activity, external engagement, attention redirect).

Part E: Practical Skills

Exercise 12 — Building a Distress Tolerance Practice

Distress tolerance is the capacity to experience difficult emotional states without immediate attempts to escape, suppress, or avoid them. It is a learnable skill, and low distress tolerance is a cross-diagnostic vulnerability factor.

Your current distress tolerance pattern: - When you feel anxious or depressed, what do you typically do in the first 5 minutes? - What is the short-term effect of that response? - What is the medium-term effect (next few hours)? - What is the long-term effect (pattern over weeks)?

A toleration practice: Choose a mild to moderate distress situation — something you typically avoid or immediately attempt to relieve. For the next week, practice the following response: 1. Notice the distress without immediately acting on it. 2. Name it specifically: "I notice I'm feeling [anxious / low / irritable] right now." 3. Sit with it for 3–5 minutes — breathe, allow the feeling to be present, without engaging in avoidance or relief behaviors. 4. After 3–5 minutes, choose an intentional response based on your values, not the feeling's urgency.

Track: What happened to the intensity of the distress during and after the practice?

Exercise 13 — Your Personal Warning Sign Inventory

Early recognition of anxiety and depression escalation creates the opportunity for early intervention. This exercise develops your personal warning sign profile.

Your earliest anxiety warning signs (things that appear before it becomes a significant problem): 1. __ 2. __ 3. ___

Your earliest depression warning signs: 1. __ 2. __ 3. ___

Your most reliable escalating factors (circumstances that reliably push you up the spectrum): 1. __ 2. __

Your most reliable protective factors (circumstances that reliably stabilize or improve your state): 1. __ 2. __

Your response plan: If you notice two or more early warning signs for either anxiety or depression, what will you do? - First response (self-care, routine adjustment): __ - Second response (if first is insufficient after 2 weeks): __ - Third response (professional support): ___

Exercise 14 — The Support Conversation

The chapter notes that asking directly about suicidal ideation does not increase suicidal risk — it reduces it. More broadly, direct conversation about anxiety and depression is consistently more useful than indirect concern or avoidance.

If someone in your life has been showing warning signs, design a support conversation:

Opening — how you noticed and why you're saying something: "I've been noticing [specific observations], and I wanted to check in. How are you actually doing?"

Listening — not solving, not minimizing, not reassuring immediately: The primary goal of a first conversation is for the person to feel heard. Resist the urge to immediately offer solutions or silver linings.

Direct question if needed: "Sometimes when people are feeling this way, they have thoughts about not wanting to be here. Is that something you've been experiencing?"

Connection to support: "I'm glad you told me. What would be most helpful right now — would it help to talk to someone who specializes in this?"

Practice: Role-play this conversation with a trusted person, or write out how you would handle it.

Reflection Journal Prompts

Prompt 1 — The Management Strategy The chapter describes how many people manage subclinical anxiety and depression through performance, busyness, avoidance, or substance use — strategies that work short-term and cost long-term. What, if anything, have you been using to manage your own distress that might be working against you in the longer run?

Prompt 2 — The Permission Question Many people delay help-seeking because they believe their distress "isn't bad enough" to justify it. The chapter notes that the average delay between first symptoms and first treatment for anxiety is eleven years. What would it mean to give yourself permission to seek support before the distress becomes severe? What would need to be different in your beliefs about mental health treatment for that permission to feel available?

Prompt 3 — What You Know vs. What You Experience The chapter distinguishes knowing the cognitive distortions from experiencing a different relationship to them. You can know that catastrophizing is a distortion and still catastrophize. What is the difference between intellectual understanding of these concepts and actually living differently in relation to your own anxiety and depression?

Prompt 4 — The Stigma You Carry Even people who consciously reject mental health stigma often carry implicit stigma — toward themselves or others. When you imagine yourself in therapy, or on antidepressants, or telling a colleague "I've been dealing with anxiety" — what is the internal response? What does that response tell you about the stigma you've absorbed, even if you intellectually disagree with it?

End of Chapter 32 Exercises