SA01 Understanding and Treating Anxiety
Disorders
Dr. David A RussLicensed Psychologist
www.turnaroundanxiety.com www.carolinas-counseling.com
Notes and Powerpoint can be downloaded from:
www.turnaroundanxiety.com/documents
1. Identifying the Core Elements of Anxiety
2. Types of Anxiety Disorders3. Explanation of Treatment4. Example of Treatment5. Question and Answer
Outline for this Workshop
1. False Alarm2. Anxiety Sensitivity3. Rapid and General4. Memorized/Learned5. Normal problem solving
backfires
Core Elements (Causes)
Disorder - Reaction significantly incongruent with circumstances
1. Intensity2. Frequency3. Interference4. Persistence
What Makes it a Disorder?
Shared Elements
PanicOCDPhobia
GAD
1. Physiological Arousal2. Cognitive Distortion3. Avoidant Coping4. Reinforcing Cycle
Specific Shared Elements
Autonomic Nervous System Sympathetic and
Parasympathetic big issue, often becomes part
of disorder Can be triggered by event,
multiple stressors, biology, etc
Fight or Flight trumps everything
Real Experience + Imagined Fear
Loss of predictabilityPhysiological Arousal
Physiology “demands” focus on danger
Problem is mental invention (What if?)
Common Distortions Over-estimate danger Feel over-responsible - guilt All or nothing Filter out positive Intolerance of uncertainty Mind-Reading
Cognitive Distortions
Attempt to solve “invented” problem1. Primary: Avoidance/Escape –
literal or imagined2. Secondary: If can’t avoid then
make it as safe as possible – symptoms get more extreme and less functional – partially effective (huge problem)
Avoidant Coping
Examples
Trigger Primary SecondaryGetting a shot don’t go distract self, don’t
look at needle, request extra anesthesia
Racing heart Don’t exert self Check pulse, have safe person with you, relaxation
Food that could cause choking
Don’t eat Have water, chew extra, eat soft food
Interacting with people
Avoid social situations
Keep topic easy, avoid eye contact, take talkative friend, have excuse to leave
Reinforcing Cycle
Trigger
View as Threat
AnxietyAvoidant Coping
No Correctio
n
1. Panic 2. Separation3. GAD4. Social/Selective Mutism5. Phobias6. Trauma7. OCD and spectrum
Types of Anxiety
Fear of Fear• Severe Distress• Out of blue• Fear of fear• Agorophobia
Panic Disorder
palpitations sweating trembling or shaking sensations of shortness of breath or
smothering feeling of choking chest pain or discomfort nausea or abdominal distress dizziness or lightheadedness derealization or depersonalization fear of losing control or “going crazy" fear of dying paresthesias chills or hot flushes
Symptoms
Fear of loss of protection/security• Characterized by extreme
fear/distress when faced with separation - home or attached adults
• Worry about safety of self and caregivers
• School refusal • Body complaints • Being alone/sleep
Separation Anxiety
Fear of things going bad• Pattern of exaggerated worry that is
characterized by attention to negative or threat related information
• Must last 3 -6 months • About multiple issues • Physical complaints: pain, nausea,
fatigueGeneralized Anxiety Disorder
Fear of embarrassment or judgment• Fear acting in way that is humiliating• Fear of judgment• Fear reaction can be panic• Performance Anxiety• Selective Mutism
Social Phobia
Fear of clearly discernible object or situation. Types
• Natural• Animal• Blood/Shots/Injury• Situational• Other - Emetophobia
Phobias
Anxiety resulting from Trauma• Physical or Natural• Re-experienced (flashbacks,
dreams, etc.• Avoidance• Numbing• Hyper-arousal
Trauma related
Fear of loss of core value• Obsessions – thoughts in focus in spite
of and contrary to desire of person. Thoughts cannot be suppressed even though not characteristic of self. Great distress as result
• Compulsions – urges to perform behavior or thinking actions to reduce anxiety or possible harm.
Obsessive-Compulsive Disorder
• Treatment for Core Elements:1. Physiological Arousal Calming2. Cognitive Distortion Accuracy3. Avoidant Courageous Coping
• Core error: Reacting to something that is bothersome as dangerous
Treatment
• Educational• Directive• Structured• Symptom Reduction rather
than insight oriented• More coach, less therapist
Approach
• Medication• Skill Training – somatic management
• Distress tolerance• Change Lifestyle
Physiological Calming
• Teach thinking about thinking
• Tracking thoughts• Identification of problem thinking
• Cognitive Restructuring
Cognitive Accuracy
1. What is the evidence?2. Are there other ways to
think about the situation?3. What is the worst that
could happen?4. What is the effect of
believing idea?Keys to Disputing Thoughts
ERP• Exposure
• Deliberately evoking anxiety• Remaining in distress
• Response Prevention• Prevent normal coping response• Not doing anything to reduce
distress before, during and after exposure
• Don’t employ Safety Behaviors
Courageous Coping
Exposure• Types
• Thought• Interoceptive• Virtual• In situation
• Create Hierarchy• SUDs• List of triggers and core fears• Put in 3 categories - Easy, Medium, Hard• Create an exposure for them
Treatment - Exposure
1.Words2.Short sentences3.Paragraphs4.Simple cartoon illustrations5.Photos of sick people (no vomit)6.Pictures of vomit7.Pictures of people vomiting8.Animated videos of vomit9.Videos of people vomiting10.Fake vomit and smell
Emetophobia Hierarchy
Safety Behavior Response PreventionDon’t look at words Stare at words, write the wordOnly do exposure with safe person or in safe place
Exposure in places where might get sick (nurses office)
Mental change to make story safe (just looking for something in toilet)
Describe story as scary as possible
Say words fast or mutter them Slow down speaking, enunciate
Subtle actions (flick, spit, swallow, change posture)
No flicking, fidgeting, spittingExample Response
Prevention
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