What Every Therapist Needs to Know About Anxiety Disorders

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What Every Therapist Needs to Know About Anxiety Disorders Page 34

by Martin N Seif


  medical procedures, fear of 91

  medication 60–1, 130, 141, 148

  medulla 83

  memories 9, 12–13, 28, 29–30

  memory aids 86–7, 192

  mental compulsions 95, 120

  mental OCD (obsessive compulsive disorder) 99, 119–21, 150, 152, 161

  mental reassurances 110

  metacognitive beliefs (beliefs about thoughts) 147

  metaphors 45–7, 149, 187–8

  meta-worry (worry about worry) 126, 132–4, 137

  mindfulness: acceptance 38–9, 43, 44, 48; “I am bigger than my thoughts” technique 80; mindful labeling 74–5; mindful sensory awareness 73; stress 86; worry exposure 139

  mindfulness-based stress reduction (MBSR) 80

  mini-avoidances 110, 111, 125

  misdiagnoses 156

  monitoring of the mind 148

  mood 148

  motivation 117

  motivational interviewing 80

  muscular tension 43–4

  needles, fear of 57

  nervous system 41, 190

  neural pathways 23–8, 35, 42, 112, 122

  neutralization 30–1, 69, 110, 114, 121

  new mothers 146, 147, 150–1, 157, 158

  Niebuhr, Reinhold 43

  “the observer” 80

  observing 43–4, 87

  obsessions: anxiety-raising and anxiety-lowering thoughts 131; diagnoses 95, 98, 100; exposure 118, 119, 120; OCD 95, 100, 119, 120; unwanted intrusive thoughts 153, 154

  obsessive-compulsive disorder (OCD): age of onset 18; anxiety-raising and anxiety-lowering thoughts 131; causation of anxiety disorders 16; classic pitfalls 156, 157, 158–62; determining patient progress 85, 86, 87; diagnoses 3, 89, 90, 91, 95–100, 101, 102; DSM-5 xv; exposure 107, 109, 114, 118–21; fear-maintaining cycle 30; fear of flying 2; first and second fear 27; getting started 56, 57, 58, 65; helpful techniques 75, 78, 79; identifying and treating avoidance 14; illness worries 176–7; intolerance of uncertainty 33; labeling anxiety 49; mental OCD 99, 119–21, 150, 152, 161; misdiagnosing OCD thoughts as a sexual issue 160–2; pathological doubt OCD 158–60; reassurance junkies 173; scrupulosity 178; types of triggers 11, 12; unwanted intrusive thoughts 152, 153, 154; value of talking about symptoms 21

  onset age 18, 91, 101

  overblown conscience 96, 158, 178

  over-diagnosis 156

  paleocortex 35

  panic attacks: acceptance 41; diagnoses 92–3, 102, 103; diaphragmatic breathing 83; first and second fear 26; panic disorder 92–3; providing information and answering questions 64–5; traumatic anxieties 102, 103; types of triggers 12, 13

  panic disorder: autonomic arousal 20; causation studies 18, 19; diagnoses 90, 92–3, 156; exposure 106, 107, 109, 114; fear-maintaining cycle 29; fear of flying 1; first and second fear 26; getting the details 56, 57; illness worries 176; labeling anxiety 48; types of triggers 10, 11

  panicogenic relaxation 44

  paradoxical nature of anxiety 34–5, 37, 76–7, 134

  parasympathetic nervous system 190

  parenting 17, 18, 22, 184

  paruresis (“shy bladder syndrome”) 65, 90, 94, 179–80

  pathological doubt OCD (obsessive compulsive disorder) 158–60

  patient progress 84–7

  perceptual distortions 33

  perfectionism 77–8

  performance anxiety 80, 94

  personality disorder 84

  personality type 18

  phenomenology of anxiety 31–4

  phobias: agoraphobia 85, 92, 103, 114; animal phobias 89, 91; aviophobia (fear of flying) 2, 102, 114; blood–injury phobias 57, 89, 91; claustrophobia 11, 14, 56, 90, 167; diagnoses 89–91, 100, 156; emetophobia (fear of vomiting) 90, 170, 178–9; exposure 105–6; getting the details 56; phenomenology of anxiety 34; specific phobias 89–91, 107; types of triggers 11, 12

  physical contact 116

  “picture in a picture” metaphor 46

  pitfalls 156–65

  planned practice 122–5

  playing with worry 139

  “pop-ups on a computer” metaphor 46

  positive thoughts 70, 134, 135

  postpartum OCD (obsessive compulsive disorder) 151, 156, 157

  post-traumatic stress disorder (PTSD) 2, 101, 102

  prayer 135, 141

  pregnancy 22

  premenstrual women 148, 149

  primary gains 17

  probabilities 140–1

  productive worry 130

  providing information 63–6

  pseudoephedrine 148

  psycho-education 54, 76, 115

  psychosis xiv, 56, 63, 64, 151

  psychotherapy 16, 21, 105–6, 162, 183–4, 186

  PTSD see post-traumatic stress disorder

  PTSD coach 84

  public restrooms, fear of 65, 90, 94, 179

  public speaking, fear of 19, 57, 121, 167

  Purdon, C. 145

  purely mental OCD (obsessive compulsive disorder) 99, 119–21, 150, 152, 161

  questions, answering 63–6

  “raising the bar” syndrome 123, 125

  rational refutation 81

  reasonable risks 32

  reassurance: acceptance 50; exposure 110, 119, 164; OCD 95, 119; reassurance junkies 171–5; unwanted intrusive thoughts 149; worry strategies 134–5, 141

  recovery: goals for treatment 5; identifying and treating avoidance 14; introducing the new paradigm 61; relapse prevention 181–6; value of exposure 28

  reducing avoidance 141

  reframing anxiety as a positive learning experience 108

  refutation 146

  relapse prevention 181–6; chronic intermittent disorders 181–2; overview 186; proper place for stress management 184–5; role of psychotherapy 183–4; role of subtle avoidance 183; when symptoms do not matter 182

  relaxation 40, 44, 60, 134, 167, 190

  religious scrupulosity 96, 158, 177–8

  repression 162

  resilience 78

  resistance 166–75; acceptance 38, 41, 51; anticipatory anxiety 167–71; avoidance, resistance, neutralization 30–1; to home practice 166–7; reassurance junkies 171–5

  retrograde amnesia 57, 86

  Rhyno, S. 144

  risks 32, 33

  rituals: avoidance, resistance, neutralization 31; diagnoses 95, 96, 100; exposure 109, 110, 111; OCD 95, 96, 100

  Robbins, C. 154, 175

  Roosevelt, Eleanor 105

  rule of opposites 76

  rumination 133–4

  SAD see social anxiety disorder

  scheduling worry time 138–9

  scrupulosity 96, 158, 177–8

  “search and destroy” process 183

  secondary gains 17

  second fear 26–8, 30, 40, 50

  secular scrupulosity 96, 158, 177–8

  selective serotonin reuptake inhibitors (SSRIs) 168

  self-discipline 39

  self-gentleness 39

  self-help 60, 111, 134, 164

  self-reassurance 120, 134, 146

  sensations: acceptance 38, 43, 44; determining patient progress 87; fear-maintaining cycle 29–30; fear of 92, 94; mindful approach 43, 74; perceptual distortions 33; types of triggers 9–11

  sensitivity see anxiety sensitivity

  sensitization: phenomenology of anxiety 31; relapse prevention 183–4, 186; role of amygdala 23–8; sensitivity and anxiety 15; studies on causation 19

  separation anxiety 184

  serenity prayer 43

  sexuality 160–2

  “shy bladder syndrome” (paruresis) 65, 90, 94, 179–80

  Sisemore, T. 115

  situational anxiety 168, 169

  situational phobias 89, 90

  skin-picking (excoriation) 97

  sleep 75, 148, 185

  slowing down to let time pass 78–9

  smartphones 86, 139

  social anxiety disorder (SAD): age of onset 18; a
utonomic arousal 21; determining patient progress 87; diagnoses 90, 93–5, 156; exposure 106, 114, 118; fear of flying 1; first and second fear 28; getting started 56, 58–60, 65; helpful techniques 76, 77; shy bladder syndrome (paruresis) 180; types of triggers 11, 12

  social skills 58–9, 80, 95

  Songify 139, 154

  specific phobias 89–91, 107

  SSRIs (selective serotonin reuptake inhibitors) 168

  staying in the present 51–2, 73, 117, 170

  stealing 57, 96, 97

  steroids 148

  stickiness of the mind 32–3, 38, 147–9, 150

  stress: determining patient progress 85; relapse prevention 184–5; stress response 23; studies on causation 18; traumatic anxieties 102; tricks that can backfire 81; worry strategies 134, 136

  “struggle switch” 82

  substance abuse 95, 102, 129, 181

  suicidality 56, 84, 133, 152, 153

  superstitions 110, 111

  supplicatory ritualized prayer 134, 135

  supported exposure 86

  suppression 134, 135

  surrendering the struggle 50–1

  sympathetic nervous system 190

  symptoms: meaning of 4; surrendering the struggle 50; value of talking about 21–2; when symptoms do not matter 182

  Talmud 14

  teaching metaphors 45–7

  techniques 67–88; anxiety management in cases of real danger 84; competence-enhancing skills 80–1; determining patient progress 84–7; diaphragmatic breathing 81–4; effectiveness of 70; emergency coping 71–2; encourage the paradoxical approach 76–7; expecting and allowing 73–4; helpful techniques 73–81; “I am bigger than my thoughts” technique 79–80; increasing doubt about anxious messages 75–6; mindful labeling 74–5; mindful sensory awareness 73; perfectionism 77–8; problem with 67–70; reminders to take care of oneself 79; role of techniques in treatment 5–6; slowing down to let time pass 78–9; as temporary help 70–1; tricks that can backfire 81; willingness to experience discomfort 80

  terror 15, 20, 21, 25, 26, 34, 48

  thalamus 23, 24

  therapeutic attitude of acceptance see acceptance

  therapist role: acceptance 42–4; exposure 115–17; therapist anxiety and a new construct 153–4; unwanted intrusive thoughts 150–4

  thought–action fusion 31–2, 41, 99

  thoughts: acceptance 37, 38, 41, 43, 50; anxiety-raising and anxiety-lowering thoughts 130–1; depression 99, 100; fear-maintaining cycle 29–30; helpful techniques 74, 79–80; “I am bigger than my thoughts” technique 79–80; living with joy despite thoughts 149–50; mindful labeling 74; phenomenology of anxiety 31, 32–3, 34; types of triggers 9, 10, 11–12; see also unwanted intrusive thoughts; “what if” thoughts

  thought substitution 134, 135

  thought suppression 81, 134, 135

  tic disorders 97

  time 78–9, 132, 185

  tranquilizers 60, 67, 68, 69

  transsexuality 162

  traumatic anxieties 101–3, 107

  treatment: cause versus maintenance 16–17; direct approach to treatment 22–3; first contact 53–4; getting started 53–66; getting the details 56–60; goals for treatment 5; initial interview 54–6; introducing the new paradigm 61–3; previous coping skills 60–1; providing information and answering questions 63–6; role of techniques 5–6

  trichotillomania (hair-pulling) 97

  triggers: characteristics of highly anxious people 7; exposure 8, 118, 164; sensitivity and anxiety 15; specific phobias 91; types 9–13

  trust 134

  “tug of war” metaphor 51

  Twain, Mark 186

  12-step method 43, 85, 181

  uncertainty: acceptance 48, 49, 50–1; doubt about anxious messages 75; exposure 115, 117, 120; illness worries 177; intolerance of 33, 158, 159, 177; pathological doubt OCD 158, 159

  unconscious reactions 24, 25, 40

  under-diagnosis 156

  unipolar major depression 133

  unproductive worry 130

  unwanted intrusive thoughts 144–55; control strategies that fail 146; diagnoses 96, 98, 99; embracing anxiety 41; emotional and behavioral avoidance 146–7; exposure 119, 120, 154–5; getting started 55, 56; how thoughts are appraised 145–6; how thoughts are maintained 144–9; living with joy despite thoughts 149–50; metacognitive beliefs 147; OCD 96, 98, 99, 119, 120, 158–60; pathological doubt OCD 158–60; physiological factors that make the mind sticky 147–9; therapist anxiety and a new construct 153–4; treating 150; turning the causation arrow around 156, 157; varieties of presentation 150–3

  urgency 132, 138

  Valium 168

  Veenstra, G. 35

  vertical descent 140

  violent thoughts 55, 56, 96

  vomiting, fear of (emetophobia) 90, 170, 178–9

  War of the Worlds 41

  washing rituals 100, 113

  “watching anxiety pass” metaphor 45–6

  Weekes, Claire 35, 171

  Wells, HG 41

  “whack-a-mole game” metaphor 188

  “what if bag” 141

  “what if” thoughts: approaching anxiety mindfully 39; characteristics of highly anxious people 7; exposure 107, 115, 117, 120; fear-maintaining cycle 29, 30; generalized anxiety disorder 101; studies on causation 19; thought–action fusion 32; worry 131, 133

  white knuckling 61, 85, 113, 121, 123, 164

  “whoosh” of arousal 25–6, 27, 28, 40

  willingness to experience discomfort 80

  Wilson, Reid 80, 137, 138

  wise mind 50, 65, 117

  worry 126–43; anxiety-raising and anxiety-lowering thoughts 130–1; ego-syntonic vs ego-dystonic worry 127–8; evaluating worry 132–3; exposure 110, 120, 121; generalized anxiety disorder 65–6, 100–1, 129; introducing the new paradigm 62–3; meta-worry 126, 132–4, 137; productive versus unproductive worry 130; rumination 133–4; strategies that don’t work 134–6; strategies that do work 136–42; therapeutic perspective 131–2; thoughts are not facts 129–30; time and urgency 132; varieties of the worry experience 127–8; worry time 138–9

  Xanax 67, 68, 69, 141, 168

 

 

 


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