Anxiety Toolbox

1. Anxiety Toolbox Melissa Fallon Jeanne Keahon Kerry Wagner Amy Clarvoe SUNY Oneonta

2. Outline Psychoeducation/Orienting the Anxious Client Assessment Fight or Flight Anxiety/Performance Curve Self-care Intervention Toolbox Exposure with Response Prevention Worry Management Mindfulness Distress Tolerance Coping with Panic Self-Talk/Automatic Thoughts Relaxation Audience Discussion of Best Practices

3. Assessment Testing BAI STAI Other Critical Areas to Assess Alcohol and Other Drugs Family History

4. Brain in the Palm of Your Hand Brain stem- the most primitive part of the brain regulates heart rate and respiration. Directly controls our states of arousal, coordinates rapid mobilization of energy in an emergency. Limbic system- added emotions to the brain�s capacities. It plays a central role of coordinating higher and lower brain structures. Amygdala- stores and processes emotional memory. Key player in triggering brain�s alarm system. Neocortex- the �thinking brain� that mediates complex information management and processing functions such as reflective analysis.

5. Fight or Flight Triggering of the brain�s alarm system by some perceived threat�release of adrenalin and other hormones, increased heart rate and respiration, shift in blood supply, instant energy. Survival or chronic stress Emotional hijacking- occurs when the amygdala reacts to a present moment trigger by associating it with a strong memory circuit from the past. Powerful emotions and messages from the past flood our present experience. The amygdala temporarily �hijacks� the effective operation of the upper regions of the brain Emotional hijacking- This neural alarm phenomenon blocks or inhibits the neocortical processes that could otherwise more thoroughly analyze the present moment trigger and keep our emotional response in balance. Neural static-limbic system blocks higher brain activity- can�t think straight when anxiousEmotional hijacking- This neural alarm phenomenon blocks or inhibits the neocortical processes that could otherwise more thoroughly analyze the present moment trigger and keep our emotional response in balance. Neural static-limbic system blocks higher brain activity- can�t think straight when anxious

6. Anxiety (Arousal)/Performance Curve

7. Anxiety (Arousal)/Performance Curve Red Zone Triggers Self-care Self-talk

8. Self-Care Physical Eat Exercise Sleep Take time off Psychological Journal Read Take time to self-reflect Psychotherapy Emotional Spend time with loved ones Give yourself affirmations, praise Cry Laugh Spiritual Spend time with nature Be open to inspiration, awe Meditate, pray Give back Workplace/Professional Take breaks Chat with co-workers Identify tasks that are exciting or rewarding Set limits Balance Strive for balance among work, family, relationships, play, and rest

10. Interventions Exposure with Response Prevention Worry Management Mindfulness Distress Tolerance Coping with Panic Self-Talk and Automatic Thoughts Relaxation

11. Exposure with Response Prevention Explaining it with metaphor (e.g. habituating to a cold pool) Subjective Units of Distress Scale (SUDS) (1-100) Creating an exposure hierarchy and adjusting it as needed Putting it into practice Start with SUDS of 50 Sit with discomfort, don�t avoid it Response Prevention Not just for OCD

12. Worry Management What is worry? Productive and unproductive worrying Planning for what you are scared of Answering the �what-ifs� Building trust in themselves Cognitive assessment of worries Best case/worst case scenarios Most likely scenario Exposure and worry Worry hour

13. Mindfulness Moment to moment non-judgmental awareness Fully present in the moment Taking a second look at our first impulse, thought, or action A practice�..a way of being Allows the old brain circuits conditioned by fear to die out to be replaced with new neural circuits Patience-allow situation to evolve, openness- curiosity without expectations, compassion � put need to manipulate and control aside mind is the sky, thoughts are clouds Patience-allow situation to evolve, openness- curiosity without expectations, compassion � put need to manipulate and control aside mind is the sky, thoughts are clouds

14. Circle of Liberation Focus Release Focus- on the breath, on the present moment, Distraction-by a thought sound, emotion or image, Awareness-become aware of the distraction, Release the distraction, Focus-Return to point of focus: the breathFocus- on the breath, on the present moment, Distraction-by a thought sound, emotion or image, Awareness-become aware of the distraction, Release the distraction, Focus-Return to point of focus: the breath

15. Mindfulness Tools Become brain savvy Focused breathing Check ins- witnessing &watching the mind Safe place visualization- activates prefrontal cortex which moderates the activation of the emotional center of the brain Mindfulness in daily practice- stop, breathe, reflect, choose Practice, practice, practice!

16. Distress Tolerance Inventory of coping strategies Radical acceptance Instruction in managing feelings Feelings are temporary Self-care/self soothing Distraction

17. Coping with Panic Panic Attack Education With Clients 3 Steps to Manage Panic Step 1-Deflating the danger Step 2- Breaking the connection between bodily symptoms and catastrophic thoughts Step 3-Avoid fighting the panic Utilizing Panic Diaries Electronic Reserve

18. Panic Diary

19. Distorted Beliefs & Automatic Thoughts Automatic pilot (mindlessness) Cognitive Distortions- shoulds, personalizing, generalizing, filtering, emotional reasoning, etc. Themes & Messages- �I�m not good enough�, �people will leave me� Coping styles/schemas Skill deficits-trouble tolerating ambiguity Skill excesses-perfectionism

20. Treatment Tools Self-instructional training- preparing for and getting through situations Reassuring and calming self-talk Disputing beliefs and countering thoughts with counterstatements, affirmations, mantras Schema Therapy Mindfulness 12 step slogans

21. Process Awareness Acceptance Honor/compassion Letting Go Replace

22. Deep Relaxation Relaxation Education With Clients Keys to Deep Relaxation Utilize it in session Daily practice-20-30 minutes per day Soothing voice and calm setting Keeping it slow and mindful Lifestyle changes Incorporating downtime Eliminating/decreasing CATS Exercise, healthy eating, sleep Time management Delegation Letting go of perfectionism Overcoming procrastination Permission to say �No� Relaxation Examples- Practiced in Session Audio Files