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NICABM Anxiety M3 Transforming a Client’s Anxiety from Fear to…
NICABM Anxiety M3
Transforming a Client’s Anxiety
from Fear to Confidence
The issue:
Something that makes a client feel safe can actually be a block to healing. What makes a patient feel safe can often do very little to reduce their anxiety level.
CBT anxiety equation: Anxiety = overestimation of danger / underestimation of coping and resources
2 approaches
Work at reducing people's sense of danger
Work at increasing people's confidence that they can cope and awareness of resources that can help them
2 main patients' reactions to anxiety
Avoidance +++. Makes it difficult to apply either approaches: you never learn that it's maybe not as dangerous as you think, or that you're able to cope with it better than you think
Safety behaviors: things we do to protect ourselves from what we believe is the danger. Same result as avoidance.
Most effective approach
Identify the type of anxiety to apply the right strategy.
Insense bodily sensations = angoisse, panic disorder
Fear of judgement, embarrasment and comparison = social anxiety
Exposure during and outside of sessions to develop confidence and skills
Define the appropriate strategy/tools for the type of anxiety
Identify the specific thoughts and images that are driving the anxiety. Becks columns and/or recreating a situation in session or in imagination.
Get them to describe their imagery in a multi-sensory way
to fully understand what the fear is about. "What did you feel in your body? What's going through your mind? You can't escape this situation, what's worst you can
imagine
will happen? do you have an image of that? What does that look like? What are you seeing? Are you hearing anything? Feeling anything on your skin? What's your experience?"
Approach for social anxiety and general anxiety disorder:
"Assertive defense of the self"
Christine Padesky, PhD
Work on the bottom part of the equation only (p. 6): developing confidence that the patient could cope with criticism and rejection, that it wouldn't be devastating.
Left-hand side of a page: List of all the criticisms and rejecting things people could say or do
Explain dorsal / fight responses that we don't want
Right-hand side of the page: Now let's imagine what you could say or do that would assertively defend themselves
Explain assertiveness + role-play assertive statements: Make eye contact. Say it like you believe it. Let's act. Who's your favorite actor? How would they say it if they were in a movie playing this role?
Progressively increase the intensity of danger in sessions and practice.
Exercises IRL
Approach for panic and panic attacks
Work on the upper part of the equation
Test the belief: Does a racing heart really mean you're going to have a heart attack?
Approach for anxiety
Understanding the balance of danger and resources
Naming what it is that they feel threatened by (phenomenology)
What is the function of anxiety/fear in a given situation?
How does it serve the patient?
Focus on building up internal resources (bottom part of the equation)