CBT-ACT for Anxiety Skills Training: Pre-session Overview

Transcription

1 CBT-ACT for Anxiety Skills Training: Pre-session Overview Topic: Learning about the impact of anxiety or stress and how to identify your values and goals for organizing this treatment protocol The impact of anxiety and stress Anxiety and stress are natural experiences of our daily lives. The feeling of stress or anxiety is necessary for our survival (you will learn about the biological benefits of these emotions in session 1). All humans have a built in alarm system that is designed to help us avoid danger, increase energy for difficult tasks, or speed up our reactions so we can make quick movements, such as running fast out of a building that is on fire. We need anxiety and stress to function in society. However, if you are reading this introduction, it is likely that your feelings of anxiety or stress have become unmanageable and overwhelming. You are now experiencing the negative effects of too much anxiety or stress. Instead of feeling energized for action, you are likely experiencing one or more of the following emotions: Fatigued or exhausted Immobilized (frozen) Fearful Anger Panic or doom Depression Discouraged, disappointed or frustrated or Helpless to control these overwhelming feelings These emotions can eventually lead to patterns of reduced performance, withdrawal and avoidance from your activities, including ones that you consider important or valuable. Because we need anxiety and stress to survive, we cannot actually eliminate these experiences from our mind and body. People who continue to try and eliminate the feeling of stress or anxiety can develop an extreme form of anxiety known as obsessive compulsive disorder where a person is driven hopelessly to control and suppress all experiences of stress or anxiety.

2 Avoidance is the most common outcome when feeling overwhelmed by anxiety or stress. The most extreme form of avoidance is known as agoraphobia where people become trapped in their home as a result of feeling extreme fear of death or frequent panic attacks. Avoidance behaviors start off as natural responses to a feeling of danger. For example, it is natural to feel like running out of a building when you hear a fire alarm go off at work or at school. You may find out that it was drill, so you calmly and slowly walk out of the building with everyone else. Nevertheless, for a few seconds your heart rate increased along with your senses (site, hearing and smell increase in sensitivity when initially feeling panicked). Furthermore, for a few seconds your body was prepared to run quickly out of the building. As you can see, your body was prepared to escape danger; so wanting to escape the situation is both natural and biological. The problem is that we can trigger our feeling of stress or anxiety through daily interactions that are not dangerous, but nonetheless, cause us to feel like running away. Avoiding negative emotions feels natural, but it isn t practical in most situations.

3 Avoidance behavors become a problem when you begin to avoid activities, social situations, or responsibilities (e.g., household chores, medical care) that you value as important. Anxiety or stress is not the actual problem, your avoidance of situations that you care about is the problem. People with overwhelming anxiety avoid situations through multiple behaviors that tend to relieve stress or anxiety temporarily, such as staying in the house when feeling panic, but eventually lead to more stress and anxiety by denying access to rewarding or essential activities. Avoidance becomes a vicious cycle where you become less tolerable of stress, you avoid more situations that cause stress, and you feel more stressed or anxious. Forms of avoidance can include: Physical avoidance is the most common form where you avoid approaching the situation, such as staying in the home to avoid social gatherings or staying in bed and calling out sick from work (when you are not sick, but feeling stressed about work related activities). Chemical avoidance is another common technique where peole escape their thoughts and sensations of anxiety through alcohol, illicit drugs, abusing prescription medications (taking more than is prescribed), or tobacco (cigarettes or chewing tobacco), such as becoming intoxicated in social situations that are likely to increase your feeling of stress or anxiety. Other foms of mental avoidance can include overeating food, watching TV, playing computer games or surfing the web for hours while neglecting meaningful activities in the home, at work, or with friends and family. Emotional diversion or avoidance is another technique that involves triggering other strong negative emotions that temporarily displaces the feeling of anxiety, such as anger, rage, hysteria or detachment (loss of all feelings). The triggering of these emotions are usally involuntary and uncontrollable once initiated.

4 These avoidance behaviors can cause more problems than they solve; thus, the vicious cycle. More importantly, these short-term solutions almost always increase your feeling of stress or anxiety over time. Another common impact of avoidance of anxiety is an increased fear and sensitivity around health concerns and the functioning of your body. You may have noticed an increase use of health care services as your anxiety or stress has increased. Extended states of stress and anxiety can lower your immune system, increase vulnerabilities to viral and bacterial infections, and cause significant disruption to the digestive system. Moreover, the general fear of deteriorating health can become a primary focus of your thoughts and behaviors leading to further withdrawal from meaningful activities. If you have tried these techniques, you are not alone, nearly everyone who experiences high levels of stress or anxiety attempts to solve the problem by reducing the feeling or avoiding the situation that causes the feeling. Reversing the Cycle and Getting Back into Meaningful Activities The MW&R program is designed to help you reverse the cycle of avoidance by helping you slowly reengage in activities that are important to you. The MW&R program will help you increase your sense of control over situations, but the goal will not be to eliminate anxiety or stress. Instead, the goal of the MW&R program is to teach you how to effectively navigate through your feelings while achieving your goals. You and your MW&R counselor will identify a range of effective strategies that you can use to: manage stressful situations, identify triggers to anxiety and how to minimize the impact of these triggers, stay on task for things that you value, and increase your tolerance for a variety of emotions, including stress and anxiety, so that you can approach all situations that are important to you. By now you have noticed that multiple references to your values and goals. The MW&R program is tailored around your values and life goals. The first step in the treatment process is to identify your values and goals and how anxiety or stress is undermining your pursuit of valued activities and goals. You and your counselor will start to develop a plan of action using Form 2: Life areas, values and activities. The form is posted next to this

5 review on the website. The form includes five life areas or dimensions of your life that can be impacted by anxiety or stress. The life goals include: 1. Relationships this area of your life includes all your social interactions with family, friends and significant others 2. Work or school this area can include your career, job, or educational goals 3. Leisure activities and hobbies this area includes all your activities for enjoyment, sports or artistic pursuits, such as playing music, writing poetry, or painting 4. Mind, body, soul and spirituality this area of your life can include all dimensions of spirituality, religion, and activities of self-care; e.g., meditation or yoga, as well as your views of your body or soul. This dimension also includes your goals for exercise, maintaining a balanced diet and sleep. 5. Daily routines and activities this domain of your life includes activities that are not necessarily valued or enjoyed, but essential to daily living, such as cleaning your home, laundry, washing dishes, tracking and paying bills, and personal hygiene Uncontrollable anxiety can impact all five of these areas of your life and the CBT-ACT program will help you gradually re-engage in all these areas. Under each life area is a section where you can begin to identify your self-defined values associated with each area. Your life is more meaningful to you if you can work toward your values. The next step involves developing a plan to get you moving toward your values. Below each value on the form is list of activities that connect you with your values. Activities are measurable behaviors that can be observed. For example, wanting to spend more time with your son is a value, but not a measurable activity; however, playing catch; i.e., throwing a baseball, with your son on Saturdays for one hour in the morning between 10:00am and 11:00am is a measurable activity. You and your counselor can begin to fill in Form 2: Life areas, values and activities. You don t have to complete all the life areas on the phone, but you can start on one or two life areas and complete the rest during the week. Form 2 can be updated over the course of the program or whenever you wish to update the plan. The form can be completed on paper or on the web through the MW&R portal (your counselor can show you how to complete the information on the portal). Once you have identified a few of your valued activities, you and your counselor can begin to select activities for you to add each week between phone sessions. You can do this with Form 1: Activity Scheduling, which is also posted on the website next to this session. Each week you and your counselor will begin to select activities for you to achieve. You can complete the form during the phone call or prior to the phone session. Like Form 2, Form 1 can be completed by paper or through the web-portal if you have access to the web..