NURS3141 2024-25 Day 2 Final Understanding and Supporting People with Enduring Anxiety PDF

Understanding and supporting people with enduring anxiety Dr. Tim Carter and Gary Payne Optional Module 2024-25 QR Code 2  Pause and reflect Kahoot Quiz! https://create...

Understanding and supporting people with enduring anxiety Dr. Tim Carter and Gary Payne Optional Module 2024-25 QR Code 2  Pause and reflect Kahoot Quiz! https://create.kahoot.it/share/anxiety/e90531f0-4ac9 -4ab9-9845-dc526a25228c  Pause and reflect By the end of today…. - Have an understanding of physical, emotional, cognitive and behavioural changes and symptoms that present in anxiety - Have an understanding and be able to describe how anxiety is maintained - Have an understanding of graded exposure - Have some ability to support someone/yourself using a graded exposure approach for simple anxiety problems  Pause and reflect Did you complete the homework? If yes, what did you learn? If no, what did you learn? Small Group Discussion: 5 mins Each group to feedback a summary of your discussion  Pause and reflect What is Anxiety? Small Group Discussion: 5 mins Each group to feedback a summary of your discussion Anxiety 7 Anxiety is an evolutionary adaptive What does this mean? Why might it have been needed in early humans? How is it still needed? 8  Pause and reflect Fear What is the difference? Each group to feedback a summary of your discussion  Fear vs anxiety Focus - Fear = response to a specific identifiable threat, short-term - Anxiety = more diffuse and generalised apprehension, longer-lasting Timing - Fear = reaction to present danger, in the moment - Anxiety = future-focused, anticipated or imagined events or outcomes Intensity and Physical response - Fear = intense, short-term, threat, immediate physiological response - Anxiety = chronic, pervasive, persistent, prolonged tension or unease Function - Fear = adaptive function, preparing body to deal with present danger - Anxiety = maladaptive, distressing and dysfunctional when excessive 10 Function of fear from an evolutionary perspective? Threat system Fight or Flight / Freeze or Fawn Threat-cue response Internal or external Fear is the most dominant emotion Hyper-vigilance to threat 11 Anxiety So, what keeps anxiety going? Cognitive distortions Intolerable sensations Avoidance 12 Cognitive distortions - which ones are common in anxiety? 13 Maintenance of chronic anxiety Anxiety Relief Avoidance 14 Maintenance of chronic anxiety Situation Anxious Non - thoughts / occurrence cognitive distortions Relief Anxiety Avoidance 15  What are the consequences of avoidance?  We never learn anything new, so situations remain threatening  Avoidance becomes more likely the more we do it  Anxiety becomes more intense the more we avoid it  Avoidance reinforces a lack of ability to cope or manage  We falsely attribute the lack of our feared consequence to the avoidance 16  Pause and reflect Making sense of different anxiety disorders Small group task: Think about a panic attack Identify typical thoughts and avoidance behaviours Consider how the avoidance maintains the problem  Panic Disorder  Typical thoughts: I'm going to suffocate’; I'm going to have a heart attack; I'm going to collapse; I'm going to lose my mind” Fear of imminent death, injury or embarrassment Catastrophic misinterpretation of physical symptoms  Internal or External Triggers: i.e. a physical sensation or a siren  Agoraphobia: Fear of public transport; open spaces; enclosed spaces; crowds; away from home alone Where avoidance due to escape being difficult or help not being available Situations always provoke fear and it is out of proportionate to actual threat 18 CBT Model I am having a heart attack I will die (100%) Escape Fear (10) Avoid Anxiety (10) Sit down Get reassurance Palpitations Sweating Breathing 19 Maintenance of chronic anxiety Anxiety Relief Avoidance 20  Pause and reflect Overcoming Chronic Anxiety or fear Graded Exposure  Pause and reflect Think of something you used to be anxious about but no longer are…. In pairs, discuss how you overcame it? What did you have to do? Maintenance of chronic anxiety Anxiety Relief Avoidance 23 Exposure and Habituation 24 Habituation curve Michelle Craske- Exposure Strategies video What does someone learn? https://www.youtube.com/watch?v=pKPgFVKVFLA Anxiety symptoms reduce over time The worst doesn’t happen Anxiety is not dangerous They can cope with the feelings 25 Graded Exposure for Anxiety Exposure to anxiety trigger Staying in it Doing nothing to distract Repeat this multiple times What does someone learn if they do? Anxiety symptoms reduce over time The worst doesn’t happen Anxiety is not dangerous They can cope with the feelings 26 Four conditions when doing Graded Exposure 27 Graded 28 Example of a hierarchy of Feared Situations Activity or Situation Anxiety rating Going into a crowded pub on my own 100 Going to a crowded pub with my wife 90 Going to a pub alone when it is not busy 85 Going to pub with wife when not busy 75 Taking the dog to a busy park alone 70 Taking the dog to busy park with wife 60 Taking the dog out on quiet street alone 40 29 Exposure Diary 30 Prolonged Remain in situation Until anxiety has reduced by at least 50% Ideally until there is little relief from leaving i.e. when someone feels there is no threat 31 Repeated 3-5 times per week Same situation or trigger Until the ‘start’ anxiety has reduced by 50% 32 Without safety behaviours or distractions Behaviours with a function to reduce anxiety (i.e. escape, distraction or things to calm self down) - Think of something you are anxious about? - How do you make it safe? - What does someone learn / or not learn if they do these? 33 Vampire Metaphor Some people believe in Vampires In order to keep safe, they wear cloves of garlic around their necks They are relived that the garlic works as they have never been attacked! How can they check out whether the garlic is working? 34 Hierarchy of fears Identify the most feared situation 100% distress Consider something the patient could do that would be uncomfortable but tolerable- ~40% Consider something which would be in the middle of these two situations Populate the hierarchy with incremental steps 35  Pause and reflect Develop a hierarchy for someone with agoraphobia Worst fear – supermarket on Saturday afternoon In pairs, develop a hypothetical hierarchy with incremental steps leading to worst fear Consider what safety behaviours may need to be dropped over the course of the exposure Exposure Homework Sheet 37  Pause and reflect Role Play Gary and Tim to set up exposure task using the exposure homework Sheet Observe and make notes then we will discuss Common problems with exposure tasks 39 Common problems with exposure tasks 40  When everything tells you not to try it, what’s the worst that can happen? 41 Homework! Face something you are anxious about (~40% anxiety) Repeat it 3 times within the week Drop any existing safety behavious Keep track by using the exposure homework sheet Read the Core Module PowerPoint Slides for Day Two on Moodle 42  Pause and reflect By the end of today…. - Have an understanding of physical, emotional, cognitive and behavioural changes and symptoms that present in anxiety - Have an understanding and be able to describe how anxiety is maintained - Have an understanding of graded exposure - Have some ability to support someone/yourself using a graded exposure approach for simple anxiety problems  Further Reading & References - APA (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). American Psychiatric Association: Washington, DC - Beck, A.T., (1976), Cognitive therapy and the emotional disorders. New York: International - Beck, A. T., Rush, J. A., Shaw, B. F., & Emery, G., (1979) Cognitive Therapy for Depression. New York: Guildford Press - Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). The Guilford Press. - Dugas, M. J., & Robichaud, M., (2007) Cognitive-Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice. New York: Routledge - Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Behav Res Therapy. 2000;38:319–45 - Hawton, K., Salvovskis, P. M., Kirk, J., & Clark, D. M., (1989) Cognitive Therapy for Psychiatric Problems. A Practical Guide. Oxford University Press. Oxford - Kinsella, P., & Garland, A. (2008) Cognitive Behavioural Therapy for mental health workers: A beginners guide. Routledge. London - Padesky, C.A. and Greenberger, D. (1995) Clinician’s guide to mind over mood New York: Guilford Press - Salkovskis, P. M., Forrester, E., & Richards, C. (1998). Cognitive–behavioural approach to understanding obsessional thinking. The British Journal of Psychiatry, 173(S35), 53-63. - Steketee G.S. (1993) Treatment of Obsessive Compulsive Disorder. New York:Guilford Press - Wegner, D. M., (1989). White bears and other unwanted thoughts: Suppression, obsession, and the psychology of mental control. London: The Guilford Press. - Wells, A., (1997) Cognitive Therapy of Anxiety Disorders: A Practical Manual and Conceptual Guide. Wiley. Chichester. 44