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Outline. Psychoeducation/Orienting the Anxious ClientAssessment Fight or Flight Anxiety/Performance Curve Self-care Intervention ToolboxExposure with Response PreventionWorry ManagementMindfulnessDistress ToleranceCoping with PanicSelf-Talk/Automatic ThoughtsRelaxationAudience Discussio
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1. Anxiety Toolbox Melissa Fallon
Jeanne Keahon
Kerry Wagner
Amy Clarvoe
SUNY Oneonta
2. Outline Psychoeducation/Orienting the Anxious Client
Assessment
Fight or Flight
Anxiety/Performance Curve
Self-care
Intervention Toolbox
Exposure with Response Prevention
Worry Management
Mindfulness
Distress Tolerance
Coping with Panic
Self-Talk/Automatic Thoughts
Relaxation
Audience Discussion of Best Practices
3. Assessment Testing
BAI
STAI
Other Critical Areas to Assess
Alcohol and Other Drugs
Family History
4. Brain in the Palm of Your Hand Brain stem- the most primitive part of the brain regulates heart rate and respiration. Directly controls our states of arousal, coordinates rapid mobilization of energy in an emergency.
Limbic system- added emotions to the brain’s capacities. It plays a central role of coordinating higher and lower brain structures.
Amygdala- stores and processes emotional memory. Key player in triggering brain’s alarm system.
Neocortex- the “thinking brain” that mediates complex information management and processing functions such as reflective analysis.
5. Fight or Flight Triggering of the brain’s alarm system by some perceived threat–release of adrenalin and other hormones, increased heart rate and respiration, shift in blood supply, instant energy.
Survival or chronic stress
Emotional hijacking- occurs when the amygdala reacts to a present moment trigger by associating it with a strong memory circuit from the past. Powerful emotions and messages from the past flood our present experience. The amygdala temporarily “hijacks” the effective operation of the upper regions of the brain Emotional hijacking- This neural alarm phenomenon blocks or inhibits the neocortical processes that could otherwise more thoroughly analyze the present moment trigger and keep our emotional response in balance. Neural static-limbic system blocks higher brain activity- can’t think straight when anxiousEmotional hijacking- This neural alarm phenomenon blocks or inhibits the neocortical processes that could otherwise more thoroughly analyze the present moment trigger and keep our emotional response in balance. Neural static-limbic system blocks higher brain activity- can’t think straight when anxious
6. Anxiety (Arousal)/Performance Curve
7. Anxiety (Arousal)/Performance Curve Red Zone
Triggers
Self-care
Self-talk
8. Self-Care Physical
Eat
Exercise
Sleep
Take time off
Psychological
Journal
Read
Take time to self-reflect
Psychotherapy
Emotional
Spend time with loved ones
Give yourself affirmations, praise
Cry
Laugh
Spiritual
Spend time with nature
Be open to inspiration, awe
Meditate, pray
Give back
Workplace/Professional
Take breaks
Chat with co-workers
Identify tasks that are exciting or rewarding
Set limits
Balance
Strive for balance among work, family, relationships, play, and rest
10. Interventions Exposure with Response Prevention
Worry Management
Mindfulness
Distress Tolerance
Coping with Panic
Self-Talk and Automatic Thoughts
Relaxation
11. Exposure with Response Prevention Explaining it with metaphor (e.g. habituating to a cold pool)
Subjective Units of Distress Scale (SUDS) (1-100)
Creating an exposure hierarchy and adjusting it as needed
Putting it into practice
Start with SUDS of 50
Sit with discomfort, don’t avoid it
Response Prevention
Not just for OCD
12. Worry Management What is worry?
Productive and unproductive worrying
Planning for what you are scared of
Answering the “what-ifs”
Building trust in themselves
Cognitive assessment of worries
Best case/worst case scenarios
Most likely scenario
Exposure and worry
Worry hour
13. Mindfulness Moment to moment non-judgmental awareness
Fully present in the moment
Taking a second look at our first impulse, thought, or action
A practice…..a way of being
Allows the old brain circuits conditioned by fear to die out to be replaced with new neural circuits Patience-allow situation to evolve, openness- curiosity without expectations, compassion – put need to manipulate and control aside
mind is the sky, thoughts are clouds Patience-allow situation to evolve, openness- curiosity without expectations, compassion – put need to manipulate and control aside
mind is the sky, thoughts are clouds
14. Circle of Liberation Focus
Release Focus- on the breath, on the present moment, Distraction-by a thought sound, emotion or image, Awareness-become aware of the distraction, Release the distraction, Focus-Return to point of focus: the breathFocus- on the breath, on the present moment, Distraction-by a thought sound, emotion or image, Awareness-become aware of the distraction, Release the distraction, Focus-Return to point of focus: the breath
15. Mindfulness Tools Become brain savvy
Focused breathing
Check ins- witnessing &watching the mind
Safe place visualization- activates prefrontal cortex which moderates the activation of the emotional center of the brain
Mindfulness in daily practice- stop, breathe, reflect, choose
Practice, practice, practice!
16. Distress Tolerance Inventory of coping strategies
Radical acceptance
Instruction in managing feelings
Feelings are temporary
Self-care/self soothing
Distraction
17. Coping with Panic Panic Attack Education With Clients
3 Steps to Manage Panic
Step 1-Deflating the danger
Step 2- Breaking the connection between bodily symptoms and catastrophic thoughts
Step 3-Avoid fighting the panic
Utilizing Panic Diaries
Electronic Reserve
18. Panic Diary
19. Distorted Beliefs & Automatic Thoughts Automatic pilot (mindlessness)
Cognitive Distortions- shoulds, personalizing, generalizing, filtering, emotional reasoning, etc.
Themes & Messages- “I’m not good enough”, “people will leave me”
Coping styles/schemas
Skill deficits-trouble tolerating ambiguity
Skill excesses-perfectionism
20. Treatment Tools Self-instructional training- preparing for and getting through situations
Reassuring and calming self-talk
Disputing beliefs and countering thoughts with counterstatements, affirmations, mantras
Schema Therapy
Mindfulness
12 step slogans
21. Process Awareness
Acceptance
Honor/compassion
Letting Go
Replace
22. Deep Relaxation Relaxation Education With Clients
Keys to Deep Relaxation
Utilize it in session
Daily practice-20-30 minutes per day
Soothing voice and calm setting
Keeping it slow and mindful
Lifestyle changes
Incorporating downtime
Eliminating/decreasing CATS
Exercise, healthy eating, sleep
Time management
Delegation
Letting go of perfectionism
Overcoming procrastination
Permission to say “No”
Relaxation Examples- Practiced in Session
Audio Files