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 Secondary

Getting 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,

fatigue

Generalized 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.Words

2.Short sentences

3.Paragraphs

4.Simple cartoon illustrations

5.Photos of sick people (no vomit)

6.Pictures of vomit

7.Pictures of people vomiting

8.Animated videos of vomit

9.Videos of people vomiting

10.Fake vomit and smell

Emetophobia Hierarchy

Safety Behavior Response Prevention

Don’t look at words Stare 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 them Slow down speaking, enunciate

Subtle actions (flick, spit, swallow, change posture)

No flicking, fidgeting, spitting

Example Response Prevention

Turnaroundwww.turnaroundanxiety.com