Personal Anxiety Emergency Response Plan

Important Contact Information

• Primary Mental Health Provider: _________________
  • Phone: _________________
• Emergency Contact Person: _________________
  • Phone: _________________
• Local Crisis Hotline: _________________
• National Crisis Line: 988

Warning Signs (Check those that apply to you)

• Racing thoughts
• Rapid heartbeat
• Difficulty breathing
• Trembling or shaking
• Feeling of impending doom
• Chest tightness
• Excessive sweating
• Dizziness

Immediate Coping Strategies

1. Breathing Exercise

   • Inhale slowly for 4 counts
   • Hold for 4 counts
   • Exhale for 4 counts
   • Repeat 5 times

2. Grounding Technique (5-4-3-2-1)

   • Name 5 things you can see
   • Name 4 things you can touch
   • Name 3 things you can hear
   • Name 2 things you can smell
   • Name 1 thing you can taste

Action Steps

Level 1 (Mild Anxiety)

• Practice breathing exercises
• Use grounding techniques
• Take prescribed PRN medication if applicable

Level 2 (Moderate Anxiety)

• Contact support person
• Remove yourself from triggering situations
• Use distraction techniques

Level 3 (Severe Anxiety)

• Call mental health provider
• Contact emergency support person
• Consider seeking immediate medical attention

Safety Plan

1. Remove access to harmful items
2. Go to a safe, quiet space
3. Call emergency contacts if needed
4. Seek immediate help if having thoughts of self-harm

Post-Crisis Review

Date: _________________ Triggers identified: _________________ What helped: _________________ What didn't help: _________________

Keep this plan readily available and review with your mental health provider regularly.