What Every Therapist Needs to Know About Anxiety Disorders
Page 34
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