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SA01 Understanding and Treating Anxiety Disorders Dr. David A Russ Licensed Psychologist www.turnaroundanxiety.comwww.carolinas-counseling.com.

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Presentation on theme: "SA01 Understanding and Treating Anxiety Disorders Dr. David A Russ Licensed Psychologist www.turnaroundanxiety.comwww.carolinas-counseling.com."— Presentation transcript:

1 SA01 Understanding and Treating Anxiety Disorders Dr. David A Russ Licensed Psychologist www.turnaroundanxiety.comwww.carolinas-counseling.com

2 Notes and Powerpoint can be downloaded from: www.turnaroundanxiety.com/documents

3 1. Identifying the Core Elements of Anxiety 2. Types of Anxiety Disorders 3. Explanation of Treatment 4. Example of Treatment 5. Question and Answer Outline for this Workshop

4 1. False Alarm 2. Anxiety Sensitivity 3. Rapid and General 4. Memorized/Learned 5. Normal problem solving backfires Core Elements (Causes)

5 Disorder - Reaction significantly incongruent with circumstances 1. Intensity 2. Frequency 3. Interference 4. Persistence What Makes it a Disorder?

6 Shared Elements Panic OCD Phobia GAD

7 1. Physiological Arousal 2. Cognitive Distortion 3. Avoidant Coping 4. Reinforcing Cycle Specific Shared Elements

8   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 predictability Physiological Arousal

9   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

10 Attempt to solve “invented” problem 1. 1. Primary: Avoidance/Escape – literal or imagined 2. 2. 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

11 Examples TriggerPrimarySecondary Getting a shotdon’t godistract self, don’t look at needle, request extra anesthesia Racing heartDon’t exert selfCheck pulse, have safe person with you, relaxation Food that could cause choking Don’t eatHave water, chew extra, eat soft food Interacting with peopleAvoid social situationsKeep topic easy, avoid eye contact, take talkative friend, have excuse to leave

12 Reinforcing Cycle Trigger View as Threat Anxiety Avoidant Coping No Correction

13 1. Panic 2. Separation 3. GAD 4. Social/Selective Mutism 5. Phobias 6. Trauma 7. OCD and spectrum Types of Anxiety

14 Fear of Fear Severe Distress Severe Distress Out of blue Out of blue Fear of fear Fear of fear Agorophobia Agorophobia Panic Disorder

15   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

16 Fear of loss of protection/security Characterized by extreme fear/distress when faced with separation - home or attached adults Characterized by extreme fear/distress when faced with separation - home or attached adults Worry about safety of self and caregivers Worry about safety of self and caregivers School refusal School refusal Body complaints Body complaints Being alone/sleep Being alone/sleep Separation Anxiety

17 Fear of things going bad Pattern of exaggerated worry that is characterized by attention to negative or threat related information Pattern of exaggerated worry that is characterized by attention to negative or threat related information Must last 3 -6 months Must last 3 -6 months About multiple issues About multiple issues Physical complaints: pain, nausea, fatigue Physical complaints: pain, nausea, fatigue Generalized Anxiety Disorder

18 Fear of embarrassment or judgment Fear acting in way that is humiliating Fear acting in way that is humiliating Fear of judgment Fear of judgment Fear reaction can be panic Fear reaction can be panic Performance Anxiety Performance Anxiety Selective Mutism Selective Mutism Social Phobia

19 Fear of clearly discernible object or situation. Types Natural Natural Animal Animal Blood/Shots/Injury Blood/Shots/Injury Situational Situational Other - Emetophobia Other - Emetophobia Phobias

20 Anxiety resulting from Trauma Physical or Natural Physical or Natural Re-experienced (flashbacks, dreams, etc. Re-experienced (flashbacks, dreams, etc. Avoidance Avoidance Numbing Numbing Hyper-arousal Hyper-arousal Trauma related

21 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 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. Compulsions – urges to perform behavior or thinking actions to reduce anxiety or possible harm. Obsessive-Compulsive Disorder

22 Treatment for Core Elements: Treatment for Core Elements: 1. Physiological Arousal Calming 2. Cognitive Distortion Accuracy 3. Avoidant Courageous Coping Core error: Reacting to something that is bothersome as dangerous Core error: Reacting to something that is bothersome as dangerous Treatment

23 Educational Educational Directive Directive Structured Structured Symptom Reduction rather than insight oriented Symptom Reduction rather than insight oriented More coach, less therapist More coach, less therapist Approach

24 Medication Medication Skill Training – somatic management Skill Training – somatic management Distress tolerance Distress tolerance Change Lifestyle Change Lifestyle Physiological Calming

25 Teach thinking about thinking Teach thinking about thinking Tracking thoughts Tracking thoughts Identification of problem thinking Identification of problem thinking Cognitive Restructuring Cognitive Restructuring Cognitive Accuracy

26 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

27 ERP Exposure Exposure Deliberately evoking anxiety Deliberately evoking anxiety Remaining in distress Remaining in distress Response Prevention Response Prevention Prevent normal coping response Prevent normal coping response Not doing anything to reduce distress before, during and after exposure Not doing anything to reduce distress before, during and after exposure Don’t employ Safety Behaviors Don’t employ Safety Behaviors Courageous Coping

28 Exposure Types Types Thought Thought Interoceptive Interoceptive Virtual Virtual In situation In situation Create Hierarchy Create Hierarchy SUDs SUDs List of triggers and core fears List of triggers and core fears Put in 3 categories - Easy, Medium, Hard Put in 3 categories - Easy, Medium, Hard Create an exposure for them Create an exposure for them Treatment - Exposure

29 1. 1.Words 2. 2.Short sentences 3. 3.Paragraphs 4. 4.Simple cartoon illustrations 5. 5.Photos of sick people (no vomit) 6. 6.Pictures of vomit 7. 7.Pictures of people vomiting 8. 8.Animated videos of vomit 9. 9.Videos of people vomiting 10. 10.Fake vomit and smell Emetophobia Hierarchy

30 Safety BehaviorResponse Prevention Don’t look at wordsStare at words, write the word Only 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 themSlow down speaking, enunciate Subtle actions (flick, spit, swallow, change posture) No flicking, fidgeting, spitting Example Response Prevention

31 Turnaround www.turnaroundanxiety.com


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