Susan Sprich, Ph.D. Director, CBT Program, MGH
Disclosures I receive royalties from Oxford University Press for coauthoring a workbook and therapist guide I receive royalties from Springer for co-editing a CBT handbook
Anxiety Impacts one in ten American adults at some point in their lives Involves cognitive, behavioral, and physical symptoms
Physical Symptoms Rapid heart rate Muscle tension Trembling/shaking Sweating Trouble breathing GI distress Difficulty Sleeping
Cognitive Symptoms Negative thoughts, assumptions or predictions e.g., I am having a heart attack., People will laugh at my presentation., This plane is going to crash. Trouble Concentrating
Behavioral Symptoms Avoidance Escape (Leaving situations when uncomfortable) Use of safety behaviors Reassurance-seeking
Types of Anxiety Panic Disorder intense anxiety symptoms, often in situations where the person feels trapped Social Anxiety disorder concern about negative evaluation (public speaking, meeting new people) Phobias anxiety pertaining to specific situations (flying, heights, seeing blood, insects, animals, agoraphobia, etc ) PTSD anxiety following exposure to a traumatic situation GAD generalized anxiety/worrying excessively
OCD Used to be considered an anxiety disorder, however, with the DSM-5, it is now listed in a separate category Treatment strategies similar to those used for anxiety disorders OC-Spectrum disorders are related to OCD (Body focused repetitive behaviors BFRBs--hair pulling, skin picking, Body Dysmorphic Disorder, Tics/Tourette s)
Treatments Self-Help Medications CBT
Self-Help There are many workbooks and apps that patients can use on their own Examples of Workbooks: The Anxiety and Phobia Workbook, The Shyness and Social Phobia Workbook, The Mindful Way Through Anxiety Examples of Apps: Mood Notes, Mindfulness, Calm
Self-Help Usually more helpful in mild cases of Anxiety Individuals need to be self-motivated
Medication Medication has been shown to be helpful in reducing anxiety symptoms Both anti-anxiety (generally short-term) and antidepressant (often longer-term) medications are used You can consult with your PCP, NP or PA about medication They may prescribe medication themselves or refer you to a specialist
Cognitive-Behavioral Therapy (CBT) A type of therapy that is present-oriented and helps people to identify ways in which their thinking patterns and behaviors can be modified to help them function better/reduce psychiatric symptoms
Simple CBT Model Cognitive Behavioral Physiological
CBT Model Anxiety (Panic) Physical (examples) Rapid heart beat Palpitations Dizziness Disorientation/derealization Behavioral Avoid situations where symptoms or panic might happen Escape Cognitive: Physical symptoms mean something is wrong (anxiety sensitivity) What if?, Uh-oh, OMG
CBT Model Excessive Worry Physical Increased heart rate Sleep problems Tension/Stress Behavioral Seek reassurance Ruminate about potential problems Keep trying to find solutions Shift from one worry to another Cognitive: This wont go well I wont make it I will go broke Something will happen to me, my family, etc.
Cognitive Therapy Just because you think something, it is not necessarily true Interpretations of situations can have a strong impact on how you feel even if the interpretation is false
Cognitive Restructuring Identify negative thoughts and related emotions Identify cognitive errors/distortions Evaluate thoughts that are ineffective or inaccurate Modify thoughts to come up with rational responses that are more realistic/effective (not happy thinking )
Behavioral Therapy Overall goal is to help patient identify maladaptive behaviors (avoidance, safety behaviors) and replace them with healthier ones gradually by: 1) exposing them to feared and avoided situations 2) asking them not to engage in any maladaptive behaviors (rituals, reassurance-seeking, safety behaviors)
Physical Symptoms Current thinking is that acceptance of symptoms, rather than control of symptoms is the goal Mostly because trying to control symptoms often backfires and makes them worse Can be done with mindfulness/acceptance strategies
Referral Help If patients have ongoing care at MGH (have a PCP or other ongoing care) they can call our intake line at 617-724-7792 and request CBT Often the wait times are long Sometimes you can get in sooner through research programs icbt is an internet-based CBT program that is available through MGH Primary Care Practices (part of the Collaborative Care program)
Community Referral Help Association for Cognitive and Behavior Therapy (ABCT) (www.aabt.org) Anxiety Disorders Association of America (ADAA) (www.adaa.org) Psychology Today (www.psychologytoday.com)
Thank You!