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