It s all defense! Winning the Anxiety Game Brief Strategic Treatment for the Anxiety Disorders. Reid Wilson, Ph.D. Anxiety Disorders.

Transcription

1 Winning the Anxiety Game Brief Strategic Treatment fr the Anxiety Disrders Sessin 103C ADAA Cnference 2014 Reid Wilsn, Ph.D. Anxiety Disrders Treatment Center 421 Bennett Orchard Trail Chapel Hill, NC [919] Reid Wilsn, Ph.D. Chapel Hill, Nrth Carlina Anxiety Disrders Panic Disrder With r withut agraphbia Generalized Anxiety Disrder Scial Anxiety Disrder Specific Phbias Obsessive-Cmpulsive Disrder Acute Stress Disrder Pst-Traumatic Stress Disrder The Prblems Attentinal bias t perceived threat Lwer threshld f prbable danger Negative mdels f future ver-represented Need fr certainty & cntrl Unrealistic expectatin fr utcme, expressed in abslute terms Separatin anxiety Need fr cmfrt CHANGE THESE! Minimize cping ability Believe they lack cntrl r are helpless Minimizing safety factrs Their Strategies CHANGE THESE! Pr strategy Rely n crutches Dependency Rituals High evidence requirements Vigilance Resist & avid Resist emtinal & physical arusal Risk aversin Resistant t change Separatin anxiety It s all defense! 1

2 They MUST alter their beliefs. Therefre Primary Therapeutic Gal: Expsure Expsure + Paradxical Intentin I want this Seek ut dubt & distress It is cunter-prductive t try t stay relaxed &/r cnfident Let emtinal & physical arusal cme frward, withut resistance Avid! Threat Expsure + Absurdly Paradxical: Mre, please! Hw d yu recver frm Anxiety Disrders? Change yur frame f reference Change yur frame f reference Frame-up the actin Act! This is serius! This is a mental game This is serius! If a fearful thught pps up, take it seriusly I must get rid f my dubt I must get rid f my distress This is a mental game The cntent f my wrries is irrelevant I want t be uncertain I want t be distressed Leveraging the Habituatin Mdel Frequency Intensity Duratin 2

3 Hnest Stance tward symptms/wrry/ uncertainty Purpsely, vluntarily, chse t want it! want mre f it want it t last want it strng Clients Orientatin Tward Dubt & Distress ABSURD! This is hrrible. I lse if this happens! I dn t want this t happen I can tlerate this happening I m willing fr this t happen I want it t happen I win when it happens! RESIST PERMIT PROVOKE Anxiety wins Client wins Yur Jb Disrder s Jb The amygdala I want this Frequency Intensity Intensity Duratin Duratin Terrified f it! Give it t me! Detached 3

4 Anxiety dminates The Gamebard Try t feel sure that everything s OK Try t get cmfrtable seek ut dubt Prvke yur wn discmfrt Treat fearful thughts seriusly treat fearful thughts absurdly Prtect & defend yurself Stay safe Detached aggress int new, unfamiliar territry Take a risk; scare yurself anxiety s mves The Gamebard yur mves 1. D NOT pay attentin t yur cntent 22 It s NOT abut the cntent It s abut purpsely chsing t feel the generic sense f uncertainty & anxiety 2. Decide that yu will handle whatever might happen (even highly unlikely, terrible utcmes.)

5 Hwever They can nly say, I can handle it if they stp catastrphizing! Threat = Cst Ability t cpe N, but, really what if it DOES happen?! BUT, wait it IS pssible that that COULD happen! BUT what if it really means smething 25 this time? Accept the wrry when it pps up Oh, well. It s fine I just had that thught. There s anxiety, giving me that bsessin again. I expected that WANT t make yurself uncertain 5. WANT t be anxius & stay anxius

6 6. If necessary, make plans & fllw them Here s hw I am ging t [prepare fr the talk, manage my anxiety in church, drive t the stre] Here s hw I am ging t [wash my hands, shwer, check the drs, prtect my family frm salmnella.] Frame-up the actin fr mtivatin Gd pprtunity t practice I want this I can take this hit I can handle this I want t be uncertain I want t be clumsy Gimme yur best sht I want my life back! I m willing t feel unsure right nw I m willing t feel anxius right nw I want this t feel intense Gimme yur best sht! I can handle this I can take the hit The art f persuasin (Surgen) (rwing) (panic, wrry mment) Be scared & d it anyway G tward what scares yu D the ppsite f what anxiety expects This is a gd pprtunity t practice Risk lsing smething Seek ut uncertainty Seek ut discmfrt I want this I must risk Open Supprt an discussin pinin Be curius abut an pinin Persuasively argue an pinin Declare pinin as the right ne Give a cmmand Chse active ver passive I'm willing t feel awkward & clumsy Lve the mat permissive dminant I want this t stick arund I want my life back! My jb is t mve frward Step 1: Create Yur Strategy: Run hills hard. 1) get bdy frward by drpping head & raising arms 2) apply energy t task 3) push frward & up 4) get faster turnver f legs Step 2: Generate Cmmands: Raise the arms Swing the arms Lk 5-6 feet ahead Shrten stride Pick up temp Once cmmands relegated t uncnscius Step 3: Frame the Actin 35 Run hills hard 6

7 Frame-up the actin as cmmands Keep mving; dn t pull ver Dn t g int the bathrm Dn t figure it ut Leave the rm nw! Call smene I must risk What happens t frequency, intensity, duratin (habituatin) when playing the game? Self-Help Frms frm Facing Panic: Self-Help fr Peple With Panic Attacks Chart 1: Practicing the Calming Skills Chart 2: Practice Creating Symptms Chart 3: Practice Creating Symptms Chart 4: Listing & Ranking My Feared Situatins Chart 5: Details f My Feared Situatins Chart 6: Preparing t Practice Chart 7: Learning frm Practice Self-Help Frms frm Dn t Panic: Taking Cntrl f Anxiety Attacks 1: OPPORTUNITIES TO PRACTICE 2: COPING WITH FEARS 3: SAFETY CRUTCHES 4: PRACTICING CALMING SKILLS 5: PRACTICING CALMING SKILLS 6: SUPPORT STATEMENTS 7: TOLERATING SENSATIONS 8: TOLERATING SENSATIONS 9: LISTING LONG-TERM GOALS 10: RANK LONG-TERM GOALS 11: SHORT-TERM TO LONG-TERM 12: CREATE SHORT-TERM TASKS 13: PLANNING EACH TASK Frmal Relaxatin and Breathing Skills transcripts t recrd yur wn 1: PRACTICING YOUR BREATHING SKILLS 2: CUE-CONTROLLED DEEP MUSCLE RELAXATION 3: GENERALIZED RELAXATION & IMAGERY anxieties.cm/seminar/attend/type/wrkshp Seminar identifier: O D E C T 7

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