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
Assessment Testing BAI STAI Other Critical Areas to Assess Alcohol and Other Drugs Family History
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.
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
Anxiety (Arousal)/Performance Curve Red Zone Triggers Self-care Self-talk
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
Self-Care Goals/PlanFrequency Physical Walk the dog Get 8 hours of sleep Make meals at home with family daily 6x/week 5x/week Psychological Emotional Spiritual Workplace/Professional
Interventions Exposure with Response Prevention Worry Management Mindfulness Distress Tolerance Coping with Panic Self-Talk and Automatic Thoughts Relaxation
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
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
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
Circle of Liberation Focus Release Distraction Awareness
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!
Distress Tolerance Inventory of coping strategies Radical acceptance Instruction in managing feelings Feelings are temporary Self-care/self soothing Distraction
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
Panic Diary WhereWhat Time Duration (minutes) Severity (0-10) What Happened Just Before
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
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
Process Awareness Acceptance Honor/compassion Letting Go Replace
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
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