• This memory aid and tool provides techniques to reduce symptoms of acute anxiety and other emotional distress.
• These individual techniques can be used sequentially or in any order or combination depending on the situation.
• Medical and non-medical personnel are encouraged to become familiar with using these techniques to help with their own stress and to be able to teach others how and when to use the techniques appropriately.
• These tools do not replace the need for specialized mental health care in cases where there is prolonged or severe distress. Contact mental health crisis team or mental health services if concerned.

Awareness

This brings your attention to the present and helps you become oriented.

1. Look at and notice your hands, your arms, your legs, your feet
2. What is your full name? Say it out loud if appropriate
3. Where are you right now? Be specific at first eg: “in this chair”, then “in the ___ hospital”, in “ (city)”.
4. What day is it? What time is it?

Breathe

Breathing helps to calm the nervous system, focus your attention and reduce panic features. STOP if you feel lightheaded.

1. Breathe in for 5 seconds, then breathe out for 5 seconds. Repeat 3 times OR,
2. Try box breathing to reduce panic: Breathe in for 4, hold for 4, out for 4, OR,
3. Slightly prolonging the exhale can help slow the heart rate. Try:
   a. Breathe in for 4, out for 6
   b. 4-7-8 Breathing: Breathe in for 4, hold for 7, purse lips
   c. When exhaling, let out a sigh or the sound “mmm”

Count

Noticing makes you more mindful and aware of your surrounding and experience. Pause for a moment and notice any details.

1. Name 3 things you can see. List them out loud if appropriate.
2. Name 3 things you can hear close, far, and from each ear
3. Name 3 things you can feel, like your feet on the floor, air on your face, clothing on your skin.
4. Name one thing you can smell and/or taste (eg. gum, a mint)

ONE THING

Focus on what must/could be done right now to regain a sense control and agency.

1. Be practical. What is the next thing for you to do right now.
2. Common examples are self care (I need to eat, sleep, shower), a task (I need to phone ___), or something meaningful
   (I need to give (name) my full attention).

TWO STRENGTHS

Reminds you of your strengths, qualities, abilities and helps you feel capable
Choose 2 strengths:

1. What are my strengths? What do other people tell me I’m good at?
2. Who could help me right now? Eg. friend, family, colleague, etc.
3. What things in my environment are here to help me? Eg. books, phone, internet, vehicle
4. What have I learned from past experience that could help me now?

THREE THANKS

Thinking about what you are grateful for shifts and broadens your attention, promotes positive feelings and can make you feel more connected.

1. What am I thankful for today?
2. Who am I thankful for right now, in my life, in my past?
3. What simple things do I enjoy and appreciate? (eg. warm drink, sunset, bath, music)
4. Consider being grateful to yourself for doing this calming practice

Source: Dr. Marcia Kostenuik MD CCFP, April 2020.