Embed Size (px)
Citation preview
RespondingtotheneedsofapersonexperiencingSocialAnxietyDisorder
Monday20July2020
Tonight’s panel
MsCatherineMadiganPsychologist
AssociateProfessorLisaLampePsychiatrist
DrCarolineJohnsonGeneralPractitioner
Facilitator:ProfessorStephenTrumble
GeneralPractitioner
Learningoutcomes
Throughanexplorationofsocialanxietydisorderthewebinarwillprovideparticipantswiththeopportunityto:
• Identifyassociations,comorbiditiesandpatternsoftreatment-seekingbehaviourofpeopleexperiencingsocialanxietydisorder.
• Describetipsandstrategiesthatcanassistsomeoneexperiencingsocialanxietydisorder.
• Demonstratetheimportanceofcollaborationandappropriatereferralswhensupportingapersonexperiencingsocialanxietydisorder.
The15minutehour
DrCarolineJohnsonGeneralPractitioner
• Engagingthepatient
• What’sthediagnosis?
• Isthepatientsafe?
Theformulation
DrCarolineJohnsonGeneralPractitioner
• Presentingproblem(s)• Predisposingfactors• Precipitatingfactors• Perpetuatingfactors• Protectivefactors
TheroleoftheMHTP
DrCarolineJohnsonGeneralPractitioner
• AMedicarecompliancetaskoratoolforengagementandrecovery?
Homework• Twotothreepersonaltreatmentgoals• Anoutcomemeasure• Someonlineresources• +/- a‘lifestory’
Psychoeducation
DrCarolineJohnsonGeneralPractitioner
eMental Health
DrCarolineJohnsonGeneralPractitioner
DrCarolineJohnsonGeneralPractitioner
Item2712andbeyond
Assessmentofsocialanxiety
MsCatherineMadiganPsychologist
• LeibowitzSocialAnxietyScale• DavidClark'squestionnaires,Safetybehaviours,Socialcognitions,Socialattitudes• Assesslevelofdepressione.g.BeckDepressionScale• Assessmentofalcoholintake• CheckforPerfectionismOCPD,OCD,GAD,BDD
WorkwithclienttocomeupwithaCBTformulationofthemaintenanceoftheirsocialanxietydisorder
MsCatherineMadiganPsychologist
• Lookattheroleavoidanceandsafetybehavioursplayinmaintainingsocialanxiety• Lookattheroleselffocussedattentionplaysinmaintainingsocialanxiety- doattention
training• Lookattheroleofposteventprocessing(doingself-criticalpostmortemsafteraneventdoes
nothelp)• Stressthatimperfect isthenewperfect,it’soktomakemistakesandlet'sgooutandmake
them.
Behavioralexperiments
MsCatherineMadiganPsychologist
• Forexample;gooutsidetheconsultingroomwiththeclient toshops,cafesetc.
Theroleofsupportgroups
MsCatherineMadiganPsychologist
• InVictoriaADAVICandARCVICrunsupportgroups andevenhavesocialanxietyspecificgroups
• Perhapsalessthreateningplacetoabandonsafetybehaviours• Grouptherapymaybeanavailableoption• Joiningahobbyorcommunitygroup- e.g.quiltingviameetupwebsite
HelpfulCBTmanualsonsocialanxiety,perfectionism,self-esteem,selfcompassion
MsCatherineMadiganPsychologist
• Clientsmayneedmedicationasverydepressed• Clientsmaypresentwithgoalsthatcannotbemetinashorttimeframee.g.imminentjob
intervieworspeechsoreferraltoGPforbetablockersmightbeappropriate
Priority1– Diagnosticclarification
AssociateProfessorLisaLampePsychiatrist
Itisimportantto:• Developadiagnosticformulationtoguidetreatment• Identifycomorbidities• Notmissadisorderthatbetterexplainsthepresentingsymptoms
AssociateProfessorLisaLampePsychiatrist
InthiscaseIwouldparticularlywanttobeclearabout:• Anxietysecondarytopersonalitystylee.g.obsessivecompulsive,avoidant• Majordepressionasprimaryorco-existingdisorder• Complextrauma• Alcoholuse
Priority1– Diagnosticclarification
Priority2– Treatmentfocusedformulation
AssociateProfessorLisaLampePsychiatrist
Developingamodeltoexplain:1. Whysymptomsoccurredinthefirstplace
• Thiswillrequirehistorytosupportbiopsychosocialvulnerabilityfactors2. Whysymptomshavepersisted
• Cyclesofmaintenance/reinforcement• Cognitive,behavioural,interpersonalandenvironmentalreinforcers
Priority3– Treatmentplanning
AssociateProfessorLisaLampePsychiatrist
• Shareformulationwithpatientandseekherinput• Providepsychoeducation:
• Anxiety,flight/fight• Socialanxietydisorder• Evidence-basedtreatmentoptions:CBT,pharmacotherapy
• Determinepatient’spreferredtreatmentapproach/es• Considerbarrierstotreatment
Priority3– Treatmentplanningcontinued
AssociateProfessorLisaLampePsychiatrist
AssessmentandinitialmanagementAssesscomorbiddisorders,substanceuse,suicidalideation,psychosocialstressors,social/emotionalsupport.
Provideadviceonlifestyle(exercise,healthyeating,sleephygiene)AddresssubstanceabuseProvidepsychoeducation
Watchfulwaitingandreview
TreatmentplanningChooseinitialtreatmentincollaborationwiththepatient,withconsiderationofseverity,patientpreference,
previousresponsetotreatmentandavailability.Mobilizepsychosocialsupports
Continuedonnextslide
Priority3– Treatmentplanningcontinued
AssociateProfessorLisaLampePsychiatrist
Initialtreatmentbasedonseverity
Mild
CBT
Moderate
CBTor
medicationor
CBTplusmedication
Severe
CBTplusmedication
Originalchartappearsin:RANZCPCPGsforpanic,SADandGAD.Andrews,G.,etal.(2018)."RoyalAustralianandNewZealandCollegeofPsychiatristsclinicalpracticeguidelinesforthetreatmentofpanicdisorder,socialanxietydisorderandgeneralisedanxietydisorder.“AustralianandNewZealandJournalofPsychiatry 52(12):1109-1172.
Initialtreatmentbasedonseverity
Mild
CBT
Moderate
CBTor
medicationor
CBTplusmedication
Severe
CBTplusmedication
Q&A Session
MsCatherineMadiganPsychologist
AssociateProfessorLisaLampePsychiatrist
DrCarolineJohnsonGeneralPractitioner
Facilitator:ProfessorStephenTrumble
GeneralPractitioner
Beforeyougo
Pleasecompletetheexitsurveybyclickingtheyellowicon
Upcomingwebinars
Inpartnershipwith31PrimaryHealthNetworks
Olderpersons,primarycareandmentalhealth- Wednesday22July
www.mhpn.org.au
JoinanMHPNnetwork
Wouldyouliketocontinuethe‘SocialAnxietyDisorder’discussionwithlocalpractitioners?
Orperhapsstartdiscussingissuesoflocalrelevance?MHPNProjectOfficersareavailabletohelpyouestablishandsupportinterdisciplinarymentalhealthnetworksacrossmetropolitan,rural,regional
andremoteAustralia.
Wehave373networksaroundthecountry.Visitouronlinemaptofindoutwhichnetworksareclosetoyouatmhpn.org.auorcontactJacquiO’[email protected].
Thankyouandgoodevening
