Week 6 - Anxiety Disorders Flashcards
The Anxiety Disorders DSM5
- Separation Anxiety Disorder
- Specific Phobia
- Social Anxiety Disorder
- Panic Disorder
- Agoraphobia
- Generalized Anxiety Disorder
Selective Mutism
Substance / Medication-Induced Anxiety Disorder
Anxiety Disorder Due to Another Medical Condition
Other Specified Anxiety Disorder
Unspecified Anxiety Disorder
Psychoeducation
Why?
Knowledge really is power!
To normalise
To educate and inform
Our job is to help the client to help themselves – and they require knowledge to do that
To dispel myths
Psychoeducation
What and When???
Right at the beginning
Prevalence rates – to normalise
Different types of anxiety – that people worry about different things
Anxiety is a normal and even ADAPTIVE
Becomes problematic when it stops people doing what they WANT to do or what they HAVE to do
Four aspects of anxiety (thoughts, feelings, behaviours, physiology)
Potential CAUSES of anxiety (trauma, learning, genetics, avoidance, reassurance seeking) – just generally at this stage
More specific information on their particular disorder
Explanation that in children and teens: it can come across as anger and frustration
What and When???
conceptualisation, children/parents, strategies
Quite early in the peace
- –Sharing of conceptualisation – here you can give more detailed information on what may have caused, and is maintaining, THEIR particular anxiety issues
- –When the preschooler / child / teenager is the client – parental information outlining all of the above PLUS information on parenting traps (e.g., allowing avoidance, providing reassurance, over-protection / over-control etc.)
When introducing particular strategies
- -Rationale behind particular strategies
- -Education on the fear response – when talking about the recognition of body signs and introducing relaxation
- -Education on the ABC model when introducing cognitive strategies
- -Education on the role of avoidance in maintaining anxiety when introducing graded and / or interoceptive exposure
Psychoed
how
As a general rule: don’t just tell them! There is a LOT of information and they will NOT remember it all
Handouts that you can go through together is useful – provide the information and then discuss how each piece of information may / may not apply to their situation
Make sure it is age appropriate!!!
Sharing of the conceptualisation:
Why?
To come to a shared understanding of what is maintaining the client’s anxiety
Work WITH them to come up with the conceptualisation rather than just present it to them; using a current anxiety example is useful
Understanding of WHAT is going on and WHY the anxiety is being maintained provides the rationale for the treatment plan
Should be based on the theoretical models, but tailored for the individual client – and when you present it, don’t use psychobabble!
Diagrams are often useful
Need to present it in an age appropriate manner
Kids – just very basic – let them draw it and colour in boxes etc.
Teens – can be more ‘adult-like’
Relaxation
Psychoeducation Recognition of anxious body signs Mindfulness Abdominal breathing PMR
Psychoeduction: The Fear Response (teens and adults only)
- Evolutionary and biological
- When there is danger our ‘Flight or Fight’ response is initiated – that is, our body prepares us to either fight (the threat) or flee from it (get away)
- Our autonomic nervous system is activated – adrenaline and noradrenaline are released
- Why? When there is a real threat, the big muscles in our arms and legs need significant blood and oxygen to fight or flee
- To get oxygen to the major limbs quickly, respiration increases so that the heart can pump faster and get oxygen there as fast as possible
- But this means that other body parts such as the skin, hands, feet and gastrointestinal system, do NOT get as much blood and oxygen as those systems are not as necessary for survival under threat. So people may get cold, tingly, numbness, digestive problems
- With increased oxygen comes increased heat – so sweating can occur
- Pupils dilate to let in as much light as possible so that we can see more (to detect threats etc) – can get visual issues
Problem: we’re not usually fighting a lion…we’re about to sit an exam, talk to somebody we don’t know, worry about an upcoming interview! So we have TOO MUCH oxygen then – lightheaded, dizzy, feeling unreal, blurred vision
Body Signs as a Rationale
Rationale:
- How we know when we’re feeling anxious
- Early detection means you can do something about it before it intensifies
- Need to first work out what our anxious body signs are
Body Signs: Children
examples:
Frank N. Stein
Body sketch – butcher paper outline for each child – mark and draw body signs
Body Signs: Teens
Get them to complete a checklist of body signs – similar to adults
example:
My Anxious Body Signs
blushing heart racing dry mouth lump in throat butterflies in stomach feeling sick / nausea diarrhoea shaking tingling / pins and needles goosebumps trembling knees feeling dizzy / faint difficulty breathing sweaty palms
Relaxation Psychoeducation (rationale and types)
Rationale
- -Anxiety leads to body signs
- -We can use relaxation exercises to calm down those body signs
Many different types – these are just a selection
- Deep breathing – to counteract the hyperventilation caused by rapid shallow breathing – helps to calm down the other body signs as a result
- Progressive muscle – muscles tense ready for flight or fight
- Guided imagery – takes us away from our worries and concentrate on something pleasant
- Mindfulness exercises – stops the mind whirring – anxiety is often future-oriented – mindfulness brings us back to the present
Tips for effective relaxation Practice! -Make a convenient time -Find a quiet and comfortable place -Keep a record of your practice
Relaxation Strategies
Abdominal Breathing
We breathe in O2 and breathe out CO2
Need to maintain a balance for the body to work efficiently
Balance is maintained by the rate and depth of our breathing
- –When we exercise – increase in O2 and CO2 and so the balance is maintained
- –When we relax – decrease in O2 and CO2 and so the balance is maintained
- –When we’re anxious we over-breathe / hyperventilate – balance tips over so we have too much O2
Leads to other body signs – dizziness, light-headedness, confusion breathlessness, blurred vision, numbness, tingling in the extremities, cold clammy hands, muscle stiffness, feeling hot, flushed and sweaty, excessive sighing and yawning
Can leave the individual feeling exhausted and tired
Abdominal Breathing
step 1
Step 1: Chest or stomach breathers?
Place one hand on belly and one on breastbone when breathe – which hand moves more?
Practice so that the hand on their belly moves more than the hand on their chest
Abdominal Breathing
Step 2: Establish breathing pattern
Relax shoulders, chest and jaw
Breathe in slowly through the nose by relaxing and expanding the tummy (hand on tummy should move!)
Do not take deep breaths – just your own depth of breath that is smooth and easy
Breathe out through the mouth, letting the air ‘fall out’ naturally
Placing a book on the stomach can help you keep your breathing slow and low
Abdominal Breathing
Step 3: Breathing Timing
Everyone is a bit different…
Generally: In for 4, hold for 2, out for 6 seconds
It that’s too hard: in for 3, out for 4 seconds and work up to 4-2-6
Can add the word ‘hundred’ after each counted number to regulate
EVENNESS of breathing is the most important
(apps, breathe 2 relax, belly biofeedback, breathing lessons, etc)
Mindfulness
Comes from Buddhist meditation practices
Being in the present moment
Being aware of what is happening both within and outside of you, moment by moment and without judgment
Use all five senses to remain and / or return to the present moment
Important to remember that the mind WILL wander – but to notice that without judgment and return to the present
Anxiety – future focused – often not living in the present, but worrying about something that may or may not happen in the future
Mindfulness exercises can help to ground those suffering with anxiety
There are all sorts of different mindfulness-based exercises
Formal – e.g., with scripts, sitting in a particular position etc
Informal – e.g., being mindful while doing mundane tasks
Progressive Muscle Relaxation (PMR)
`When we are anxious, our muscles tense, getting us ready to fight or flee
But again…there is no lion! There is nothing physical to fight or flee from and so our muscles can remain tight and lead to aches, pains and tension headaches
PMR teaches clients the difference between the tense state and the relaxed state
Not only is it progressive in terms of the different body parts one turns their attention to, but we can also teach it ‘progressively’ as well
Many different versions of this…
Cognitive Work
various techniques
Many more cognitive techniques than there are cognitive theories! The usual suspects:
- Explanation of the ABCD model
- Identification of negative automatic thoughts – dysfunctional thoughts record
- Identification of cognitive distortions
- Identification of underlying core beliefs – downward arrow technique
- Cognitive challenging techniques
- Replacing unhelpful thoughts with helpful ones
- Coping self-statements
- Problem solving
In fact…whenever you are working with thoughts in whatever way…you are doing cognitive therapy…that includes ‘accepting’ the thoughts
potential cognitive treatment./techniques (the way we like to do it)
Some steps – not exhaustive – just some ideas:
- -Explain the cognitive model
- -Ensure they understand the cognitive model
- -Teach them about different thinking styles
- -Teach them about coping statements
- -Teach them about cognitive restructuring
Ways to help teach:
- -Explain the material
- -Get them to practice with non-personal examples
- -Get them to practice with personal examples
Explanation of the ABCD Model
Antecedents: Event/Situation
Beliefs: Thoughts
Consequences: Emotions
Do: Behaviour
When an event (A) happens, it is our thoughts and interpretations of the event (B), & not the event itself that leads us to experience certain emotions (C), and act in particular ways (D)
The Thought-Feeling Connection
Need to get across to the client that situations do not lead to our emotions, but rather, our thoughts lead to our emotions
Children as young as 7 years can do this!
It’s very important that they understand this
Use stories (for adults too!) to help them understand the connection
Use exercises to ensure and cement that understanding
What are thoughts?
Thoughts are what you say to yourself in your head
Different thoughts lead to different types of feelings
Sometimes thoughts can be pictures in your mind, rather than words.
It can sometimes be difficult to notice thoughts because they seem automatic
You can control your thoughts and choose to think in helpful ways
(It may sound strange, but not all teenagers know what you mean when you talk about ‘thoughts’.
This section aims to educate teenager on the characteristics of thoughts)
Connecting thoughts and feelings examples
match the thoughts with the feelings:(for children)
eg. “I have no one to play with” > Lonely
Thought Bubbles (for children):
- event: kates mum is late to pick her up from school
- thought: “mum has forgotten about me”
- how would kate feel? - shitty
- what would kate do? - cry
Feelings Detector: Teens
eg. nick has started at a new school, thought: “I have no one to sit with at lunch”, feeling: ….
Mind Reader: teens
eg. Meg is about to do a school exam, she feels really nervous what might meg be thinking? “fuck i wish they told us what was actually going to be assessed”
Activating helpful thoughts:
unhelpful thought, leads to feeling nervous leads to making excuses to not going on date: VS making a helpful thought, leading to less nervousness, goes on date.
