EA Psychotherapy Final Exam - Anxiety Flashcards
What set of three questions can assist to reduce the fear in anxiety?
Main questions for the individual steps of PP (Personal Positioning)
PP 1: Basic question: What causes concrete fear and where do you get the information that the negative can occur? → 3 objectives:
a) Verifying the certainty of knowledge:
Are you sure it’s like that? - Where do you get the knowledge from? - Is it knowledge?
What is real and factual?
[Breaking through pathological explanations / notions that have arisen on the basis of a high level of anxiety and provide “security” – a security that is all the more strongly grasped in anxious uncertainty, but which increases fear even more like in a vicious circle. → Learning to endure uncertainty; being able to leave things open; = application of epistemological basic knowledge]
b) Concretion and approach to reality:
How can you see that? - What is the basis of this knowledge?
c) Anchoring in reality
How will it be in real life? - What do you think will happen in real life?
PP 2: Basic question: What can I endure once?
a) Expectations and renunciation:
Do you need this in this particular situation - must it happen on this occasion? Does it take something away from me if I don’t get it this one time? What is it going to take away from me? Could you do without it this time?
b) Learning to endure a possible failure:
In this particular situation, could you bear it once, if what you fear happens?
…endure the negative consequences this one time? – Decision to being able to do something: Are you willing to (again) endure this misfortune? Þ Integration of possible failure into life = creation of reality with regard to existence (by this reference to the reality of existence → inner support → treatment of anticipatory anxiety)
c) Personal statement:
What do I think of what will be said/happen to me? Is it true, perhaps? Can I say, “Yes, that’s the way it is?”
PP 3: Basic question: What is this situation actually all about for you?
a) Attitude: What am I doing it for?
Why do you want to do it? - What is this about for you?
b) Values: What is important/valuable to you personally? - Why don’t you want to let it Be?
List the steps of therapy for panic.
First Section - Exploratory Supporting
Let the patient talk about5 what happened
Have them described the last episode - look at one concrete attack
Look at the trigger, the situation that produces the experience
Ask them what they did do so far
Two Explanations
There is no panic without fright
Panic is connected to mortality and this interpretation leads to exaggerated reactions
Main point: one does not get panic, one makes panic. You are not a victim, rather you
have something you can change, like training in breathing.
Second Section - Concrete Panic Instrument
Step A): The client must know what the triggers are. Then we train the client in breathing. It is impossible to panic with good breath.
Step B): Concentrate on the narrowness and pressure. Discover where freedom is lost and they feel forced. Create experience of space and support. Perhaps give object (e.g. acupressure, breathing in bag)
Step C): medication (SSRI, tranquilizer) can lower anticipatory anxiety
Third Section - Training of the Phenomenological Attitude of “Letting Be”
Train to watch quietly what happens. Create self-distancing by noticing physiological symptoms, allowing them, and accepting them rather than letting them lead us into panic.
Fourth Section - Confrontation
Phase 1: Work on Anxiety Itself (up to Gate of Death).
Phase 2: Look at the Existential Background. Biographical work. Through the window of the panic you come to a broader background.
With what attitude do I live? With what do I pressure myself? With what do I make my life so narrow? What are the expectancies, claims, needs, or life philosophy?
The first step of therapy for OCD is to give space for talking, and after that there are several more treatment focuses that can be applied in varied order. Name them.
a) space for talkikng
b) education
c) cognitive attitude
d) life attitude
e) advice for what to do
f) inner dialogue
g) self-distancing and de-reflection
h) interpositioning
i) confrontation
j) paradoxical intention
k) biographical work
l) medication
What is the De-Reflection Method and when would it be good to apply?
Developed by Frankl in 1947.
PPM (Personal Positioning Method) prepares us for De-Reflection.
It is more of an attitude than a method because it does not describe steps.
The term “De” means “away” combined with “Reflection”.
It is looking at the positive, the value and the meaning of the situation (similar to Step 3 in PPM).
Used when someone is hyper-reflecting or ruminating (thinking too much about something) about a feared content.
Example: When you worry because your child has not come home yet. I am waiting and worrying, but I could do something valuable instead of thinking about the negative outcome.
Hyper-Reflection:
Is an exaggerated ruminating of thoughts, which do not lead to a result about a theme that one is anxious about, or a wish about success. Thinking too much about the fear makes the fear much bigger. This thinking goes around and around and doesn’t lead to a result. We are thinking less about the process then and the probability of success decreases.
Therefore, instead of ruminating on these thoughts, do something valuable; life will be reconnected with something that gives support, some aspect of real life.
The Attitude of De-Reflection:
Is basic in all activities that do not depend on my intention, where I should not intervene (example: sweating or blushing). It does not belong to my field of activity because it is caused by a stimulus and I do not have control over it. If I try to intervene, I am disturbing the process.
Where we cannot control things, we should let them be. We have to let existence happen.
The more we strive for happiness, the less we are happy (Frankl).
Example: Let sexuality happen rather than concentrating on it, focus on your partner instead; when the side effect becomes central, we devalue the person behind it.
De-Reflection supports the phenomenological attitude to let things happen, to let things be open and free. This is to limit oneself to one’s own field of activities and to the ways one can contribute to existence. This method detracts attention from something uncontrollable and guides one towards possibilities of acting in the actual situation.
The aim is to re-establish self-transcendence and an attitude of letting be what does not directly depend on our attention. For Frankl, this was a way to reinstall self-transcendence when it is lost. De-reflection is to work against a neurotic development, which is felt by self-observation and loss of connection with the valuable contents in the world.
Areas of Application: autonomic responses, sleep, emotions, relationships, pleasure, and sexual desire (we cannot produce love, hope, happiness).
Sleep Disorders. When one is Fixed in a problem. Sexuality Disorders. When One Ruminates About Succeeding.
Give a description of Paradoxical Intention and also write when would it NOT be good to apply PI?
PI is a wish or intent to do paradoxically what we feel or what we are afraid of.
The perfect example for using paradoxical intention is when the client may know cognitively there is no danger, but somehow feels that there is some sort of danger.
We do not apply PI if: there is realistic danger, if the client cannot know cognitively that there is no danger, or if the thought of the danger cannot be endured.
In the attitude towards anxiety, describe the conceptualization behind:
“I can only let life be.”
Letting be = capacity
I let my existence be → and paradoxically, I discover that this letting be is an act, a deed. It is also a capacity, a capacity without doing, perhaps a spiritual “capacity of powerlessness” towards being: Admitting that I can’t do anything anymore is the highest form of capacity! Being able to do nothing more and yet find a capacity in it, the capacity of letting be - this is something that sets me free, makes me “unconditionally free.”
Paradox of life: Wishes, goals, will and ideas are important for the shaping of life. And at the same time, in the abyss, paradoxically enough, we need the willingness to let life be free, to let it come as it comes and to let it be as it is, despite our efforts. This attitude of letting be conveys: “I wish it, I want to try it that way - but if it doesn’t happen, it’s OK too!” And in spite of this last letting be, I want to be active and shape my life with all my might. If this were lacking, it would be fatalism.
Describe some key characteristics of panic.
There is a storm of movement when confronted with death as opposed to general anxiety. This speed is characteristic to panic. A surprising feeling is an indicator too. Suddenly and shocking. The surprise means I did not count on it, I was not prepared. Surprise means that for a moment I lose my holding structure, my orientation. All of a sudden, my ground is shaken. There is a flood of anxiety and an immediate rejecting attitude of “I don’t want to die”.
What does it mean to be surprised?
There is a difference between panic feelings and panic attacks. Feelings of panic happen to everyone, but people with certain physiological dispositions are more prone to panic disorders. They are common in people with reactive histrionic personalities (impulsive, fast tendencies). Also, someone who has lots of fundamental trust will not fall as easily and will be less likely to have panic feelings. Panic disorder is not likely in phlegmatic personalities (cool and calm with a different cognitive style of a low level of reactivity).
In the treatment of fundamental (basic) anxiety, what are some ways that the therapist can provide / facilitate support and grounding in the client?
Needs the presence of “otherness” which gives support and where I feel acceptance.
This feeling of support and firmness, the being itself gives the hold. This is very important in the therapeutic relationship that the therapist is clear that they can support the patient in his or her anxiety (they endure with them). It is the looking together at what is there and the work is mainly with perception (FM1). We let them describe their anxiety so that they can connect themselves with reality.
Also do body or physical investigations.
Do you see this table?
Do you feel you are sitting on the chair?
Can you feel that you are breathing?
Are you willing to rely on it? (the chair, your breath)
We look at the concrete realities that are there. This helps clients get the training of concreteness in the small things and strengthens the perception of their own capacities.
Describe the flowers?
What am I able to do?
This helps them trust themselves.
Clarify problems and keep them concrete (examples: financial problems, sickness).
What is the problem? Describe it? What elements of it are influencing you?
Are there problems in your life that make you insecure?
Looking for impairments of stability.
Then we work on contents to look at trust in general (basic and fundamental).
Where are there experiences of being held and accepted?
Go to a place where you once experienced hold, quietness?
We want to experience an ontological basis.
This also belongs with the ultimate horizon from which existence extends.
There may be sources of continual impairment of your ability to trust (example: like a bad relationship that undermines you).
Create an ontological basis for trust.
Go to a place where you once experienced peace, no anxiety?
Use this for a beginning.
Look at irrational beliefs and cognitive dysfunctions.
Medication may also be necessary.
During this time of therapy, they need to know the therapist is there; like the child who cries out in the dark. Be available and be reliable.
Why is it important to encourage someone with social phobia to learn to take their own position towards themselves?
Some questions to ask:
What do you think personally about yourself?
What do you evaluate about yourself?
This is to take a position toward self.
The encouragement is to be in contact with your own reality. Often clients will find when asked that they have this vision of themselves that it is not at all about how others see them. The problem with these visions and expectations is that they are often not based on reality.
We fight reality and make ourselves weak and vulnerable to others comments. A typical pattern is we do not admit ourselves about what is real in our lives, and we project on others that they might see it or judge us.
Explain the Personal Positioning Method and what types of suffering it is helpful for or not.
PPM:
This is a method that is reportedly used most by EA therapists in practice to ascertain one’s personal position (for anxiety and depression). Activating the person for to counteract the behaviour tendency of that suffering (examples: feeling helpless in anxiety, letting things go in depression).
This method is resource oriented and it is applied in counselling. It does not work through trauma or disorders. It is to work at the level of capacity to do something in spite of and is related to the defying power of the human spirit (Frankl).
This work interferes with the pathological attitudes/behaviours that maintain the problems.
The PPM can also be used in crises intervention (example: when a partner shocks a Person by saying: “I am leaving”).
Step 1 - Toward the Outside (Perception)
Step 2 - Toward the Inside (Positioning)
Step 3 - Toward the Positive (Decision)
