Anxiety Toolbox

Melissa FallonJeanne KeahonKerry WagnerAmy Clarvoe

SUNY Oneonta

OutlinePsychoeducation/Orienting the Anxious Client

Assessment Fight or Flight Anxiety/Performance Curve Self-care

Intervention ToolboxExposure with Response PreventionWorry ManagementMindfulnessDistress ToleranceCoping with PanicSelf-Talk/Automatic ThoughtsRelaxation

Audience Discussion of Best Practices

AssessmentTesting

BAISTAI

Other Critical Areas to AssessAlcohol and Other DrugsFamily 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 FlightTriggering 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 stressEmotional 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

Performance

Arousal/ Anxiety

Anxiety (Arousal)/Performance CurveRed ZoneTriggersSelf-careSelf-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

SpiritualSpend time with natureBe open to inspiration, aweMeditate, prayGive back

Workplace/Professional Take breaksChat with co-workers Identify tasks that are

exciting or rewardingSet limits

BalanceStrive for balance among

work, family, relationships, play, and rest

Self-Care Goals/Plan Frequency

PhysicalWalk the dogGet 8 hours of sleepMake meals at home with family

daily6x/week5x/week

Psychological

Emotional

Spiritual

Workplace/Professional

InterventionsExposure with Response PreventionWorry ManagementMindfulnessDistress ToleranceCoping with PanicSelf-Talk and Automatic ThoughtsRelaxation

Exposure with Response PreventionExplaining 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 practiceStart with SUDS of 50 Sit with discomfort, don’t avoid itResponse Prevention

Not just for OCD

Worry ManagementWhat is worry?Productive and unproductive worrying

Planning for what you are scared ofAnswering the “what-ifs”Building trust in themselves

Cognitive assessment of worriesBest case/worst case scenariosMost likely scenario

Exposure and worryWorry hour

Mindfulness Moment to moment non-judgmental

awareness Fully present in the momentTaking a second look at our first impulse,

thought, or actionA practice…..a way of beingAllows 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 ToolsBecome brain savvyFocused breathingCheck ins- witnessing &watching the mindSafe 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 ToleranceInventory of coping strategiesRadical acceptanceInstruction in managing feelings

Feelings are temporarySelf-care/self soothingDistraction

Coping with PanicPanic Attack Education With Clients3 Steps to Manage Panic

Step 1-Deflating the dangerStep 2- Breaking the connection between

bodily symptoms and catastrophic thoughtsStep 3-Avoid fighting the panic

Utilizing Panic DiariesElectronic Reserve

Panic Diary

Where What Time

Duration (minutes)

Severity (0-10)

What Happened Just Before

Distorted Beliefs & Automatic ThoughtsAutomatic 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 ToolsSelf-instructional training- preparing for and

getting through situationsReassuring and calming self-talkDisputing beliefs and countering thoughts

with counterstatements, affirmations, mantras

Schema Therapy Mindfulness12 step slogans

ProcessAwareness

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