Anxiety

Question 1

Introduction

Answer 1

• DSM-V
  • Clients with GAD who engage in worries surrounding situations they find themselves in and surrounding worries about the future. (Dugas, 2001) and (Borkovec et al, 1991)
  • Consequently, cognitive avoidance is negatively reinforced, preventing emotional processing of fear-related stimuli. Borkovec et al. (2004)
  • These worries can be separated to hypothetical worries and practical worries. The client often has little control over Hypothetical worries whereas practical worries can be solved and worked on.
  • Worry management focuses on worries that are hypothetical that the client has little control over.
  • Greer et al (2010)

Question 2

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Answer 2

• Worry management works on scheduling worry time for hypothetical worries
• Allows the client to let go of these worries for the rest of the time
• This illustrates that the worries are within their own control. (Michie et al, 2011).
• 5 stages to Worry Management (Papworth and Marrinan, 2018)
o Introduce the approach
 Orientate the client to the idea of hypothetical vs practical worries
 Explore the impact that worrying has on the client and on the situation/ focus of the worry (should accentuate the increase in anxiety and associated physiological symptoms e.g. tension and poor sleep, this makes it more difficult to concentrate on the present

Question 3

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Answer 3

o Schedule in Worry time
 Decide on a time when they are going to choose to worry and for how long; usually 20mins daily practice
 This can be shortened or lengthened once practiced
 Person should be free from distractions/ disturbances during worry time. -important to make this clear to the client.

Question 4

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Answer 4

o Make a list of hypothetical worries and focus away from the worry
 List hypothetical worries throughout the day, make a fresh list each day
 Make it clear that they will focus fully on these worries during worry time
 If practical worries arise use problem solving if possible.
 Practical worries can be identified using the worry tree.
 Redirect focus away from the worry by focusing attention on current activities and engaging fully in the experience -> (Roemer and Orsillo, 2002)

Question 5

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Answer 5

o Use the worry time
 Read hypothetical worries and work through them using their full attention
 May find worries have passed so can be crossed of the list
 Once worry time is over worries should be put away and focus should be redirected to the present
 May be useful to cross of worries or throw the list away to mark end

Question 6

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Answer 6

o Review the learning
 Self-help materials (Chellingsworth and Farrand, 2016)
 Often clients have reduced anxiety -useful learning that thoughts pass
 If can’t focus on worries (Leahy, 2004)

Question 7

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Answer 7

• Limited evidence of worry-time being used as a singular treatment
o NICE (2011):
o E- Paxling, 2011
• Also found useful for Sleep
o Fiorentino et al, 2010
o E- could be the relaxation techniques that are effective in helping clients sleep
 Alexandru et al, 2009
 Saeedi et al, 2010
o PMR (Jacobson et al, 1938) is also useful for treatment of tension another symptom of GAD
 Arntz, 2003
• E- must be careful not to use with Panic as it may reinforce the idea about anxiety symptoms being dangerous

Question 8

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Answer 8

• It takes time and practice to work
o Can be difficult to disengage from the worries and focus on the present
• Chellingsworth and Farrand (2016)
o Practitioner could do exercise on focusing
• Client may be anxious about deliberating worrying -helpful to encourage an experiment to see what they learn -many realise they have more control than they had thought.

Question 9

Conclusion

Answer 9

• WM can be used when a client is having worries that they feel they have little control over usually seen in Anxiety
• There is a small but promising research base for WM
• Having awareness of its possible difficulties could improve engagement of client.