Coun 106 final

Anxiety and Anxiety Management COUN 106 Marisa Mariano, MFT

Agenda 8:30-8:45 Attendance/Intro 8:45-10:30 Class 10:30-10:45 Break 10:45-12:00 Class 12:00-1:00 Lunch 1:00-3:00 Class 3:00-3:15 Break 3:15-4:15 Class 4:15-4:30 Closing

“Bad with your nerves” “A worrier” “Stressed out” “Unable to relax” “Tense and nervous”

Objectives Recognize whether or not you may be suffering from symptoms of anxiety Understand what stress, anxiety and anxiety disorders are, what can cause it and what can keep it going. Overcome your anxiety by learning better ways of coping with it.

What is Stress? Class brainstorm Stress can be defined as our mental,physical, emotional, and behavioral reactions to any perceived demands or threats.

Fight or Flight Physiological reaction (racing heartbeat, breathing rate increased, dilated pupils, tense muscles, and mind process information rapidly). When presented with a threat => our bodies react quickly to supply protection by "turning on the juices" and preparing to take action. This physiological reaction is known as the "fight or flight" response. Example : Caveman and tiger

Example #2: Public Speaking In groups, draw/list some examples of signs of stress in these various areas: Physical Behavioral Cognitive Emotional

Signs of stress Physical Increased heart rate Clammy or sweaty hands Physically shaking Rapid and shallow breathing Jaw tightens Light-headed Behavioral Stuttering Looking down a lot Avoid eye contact with the audience Absence on day of presentation Rushing through presentation

Signs of stress (cont’) Cognitive Your mind may go blank Your thoughts might race wildly. You might have thoughts about making a mistake or looking ridiculous in front of your peers. Emotional You might feel Very anxious Fearful Resentful/Angry Frustrated

Now let’s determine what your stressors are… Please fill out the handout “What Seems Stressful To You”. What are the different situations in your life that are causing the most stress at this time? One of the first steps to managing stress is to be able to identify what the stressors are in our lives.

Remember: Stress is a normal part of life! It can help us: ,[object Object]

React appropriately to (a) situation(s)

Adds flavor to our lives,[object Object]

When stress and anxiety become a problem When the symptoms are: Severe and unpleasant Going on too long Happening too often Causing us to worry that there is something serious wrong Stopping us from doing what we want to do

What can lead to stress? Stress generally comes from 4 main areas: ,[object Object]

Four main sources of stress Physiological adolescence, illness, accidents, lack of exercise, poor nutrition, alcohol or drug use/abuse, sleep disturbances, muscle tension, headaches, upset stomach Thoughts Our perception of events, expecting too much from others, making decisions, having a pessimistic attitude, expecting problem-free living, worrying, being a perfectionist, being competitive, being self-critical, making assumptions

How can too much “stress” affect us? Affect our physical and mental well being. Interfere with our normal daily activities. Diminish our self-esteem. Impair relationships. Decrease work and academic effectiveness. Can lead to self-blame, self-doubt, feeling burned out, or becoming clinically anxious or depressed.

Some important facts about stress: 43% of adults experienced adverse health effects from stress 75-90% of visits to a physician's office are for stress-related conditions and complaints Stress has been linked to the 6 leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide In the workplace, stress may be related to lost hours due to absenteeism, reduced productivity, and worker's compensation benefits. This costs the American industry more than $300 billion annually.

How vulnerable are you to stress? Fill out ‘Vulnerability to Stress Worksheet”

Why do we “stress out”? We stress out for 2 main reasons: 1) We perceive a situation as dangerous, difficult, or painful. 2) We don't believe we have the resources to cope.

Perception and stress How we perceive an event + the meaning we give to it = level that we feel stressed or not stressed about it. (Example: reaction to test results) Irrational beliefs that we have about ourselves also impact how well we can handle stressful events in our life. Ellis’s A  B  C A – Activating Event B – Beliefs C – Consequences (ability to cope) Ex. Losing a job

Irrational Beliefs Do any of these sound familiar to beliefs you may have of yourself or messages you have heard in your life?

How to address irrational beliefs? Remember this will require some work and won’t happen over night. First, develop awareness of the thoughts that seem to be making you unhappy/miserable Next, evaluate the accuracy of the thoughts. Then, prepare thoughts that are incompatible with the irrational thoughts and practice saying them firmly to yourself. Finally, reward yourself with a mental pat on the back for making effective changes in your beliefs and thought patterns

Now… Let’s try to address some of our irrational beliefs…

Identifying Irrational Beliefs that blow stressors out of proportion. First let’s look at some examples (refer to the handout). Do any of these sound familiar to you? Now, turn the paper over and fold it in half (vertically). Keep the paper folded. On one side write down some irrational beliefs you feel you may have or critical messages you may tell yourself. On the other side, how are some new ways (rational alternatives) of looking at the situation that keep things in perspective?

Some stress warning signals Important to be aware of external and internal warning signs. What are your stress symptoms when you feel stressed out? Fill out the “Stress Warning Signals Worksheet”

12 Suggestions for Reducing Stress Find a support system. Change your attitude. “Life is 10% what happens to us and 90% how we react to it”. Be realistic.

12 Suggestions for Reducing Stress (continued) Get organized and take charge! Take breaks, give yourself “me” time. Take good care of yourself.

12 Suggestions for Reducing Stress (continued) Learn to say “no”. Get regular exercise. Get a hobby, do something different.

12 Suggestions for Reducing Stress (continued) Slow down. Laugh, use humor. Learn to relax.

Activity: “The Way I Think” Answer the following questions on a separate piece of paper. 1) “I often worry that I _____________.” 2) If this worry of yours was indeed true, what does it mean to you and why does it bother you so much? 2b) If what you JUST wrote was indeed true, what does it mean to you and why does it bother you so much? 2c) If what you JUST wrote was indeed true, what does it mean to you and why does it bother you so much?

Activity: “The Way I Think” (cont) 3) What’s the worst thing that could possibly happen? What do you fear most of all? 4) When you think of the worst thing that could happen, do you really think that it’s likely to happen? If so, how could you learn to cope with it? 5) What do I (perhaps “secretly”) get out of thinking like this? How does it work to my advantage?

Activity: “The Way I Think” (cont) 6) Letter to your friend. Pretend your friend has some of the same worrisome beliefs that you do. Pick out one of the statements from questions 1-3 and write it down. Write a compassionate, rational, and realistic response to your friend’s statement Next line: Have your friend reply. Next line: respond again to your friend…try to keep the conversation going for 10 lines or so.

Activity: “The Way I Think” (cont) 7) Positive imagery antedotes Select 3 positive images (real or imaginary) related to: 1) confidence and strength in your life, 2) safety and peacefulness in your life, 3) love in your life 8) I accept myself even though I _____________. Do not use the word “am” Now write this down 10 times!! Adaptive self talk and positive thinking

2 Types of Relaxation Exercises Deep Breathing When we are stressed our breathing becomes shallow and our frequency of breaths increase. Allows us to take fuller, slower breaths that reflect a true relaxed state. Visualization Giving our minds and bodies a “mini vacation”. Using imagery to fully immerse ourselves in a pleasant scene, noticing the sights, sounds, smells, and tactile sensations

Guided Visualization Exercise An example to relaxation exercises.

Discussion questions Where did your visualization take you? Do you feel more calm/relaxed after going through this exercise? What did you see, hear, feel, smell during your visualization/did anything in particular stand out? What was it like throwing your burdens into the water? How does it feel to be back in the classroom? Is this technique/exercise something you might do in the future to clam down, relax and reduce your stress?

Additional tools to managing stress and anxiety Anxiety Diary For 2 weeks or more, keep an hourly diary of your anxiety and activity level. Rate anxiety from 0-10. Problem solving (with realistic worries or problems) Write down a problem. Write down as many possible solutions as you can. Chose the best solution and write down all the steps to achieve it.

Stress/Anxiety vs. Anxiety Disorders Recap: Stress/anxiety is inevitable part of life. Anxiety disorders 1) more intense than normal stress 2) lasts longer 3) leads to phobias that interfere with life Anxiety Disorders – criteria is established in the DSM-IV-TR

Types of Anxiety Disorders Phobias Specific Phobia Social Phobia Agoraphobia Panic Disorder Generalized Anxiety Disorder Obsessive Compulsive Disorder Post-Traumatic Stress Disorder Acute Stress Disorder

Phobias Example (Arachnophobia): http://www.youtube.com/watch?v=5ksMw4MJgn0&feature=related What did you notice? Specific Phobia: an excessive, irrational fear of a specific object or situation, such as snakes or heights. Examples include claustrophobia (fear of tight or enclosed spaces) and acrophobia (fear of heights). Social Phobia: Also called Social Anxiety Disorder, a social phobia is a persistent fear of social interactions in which one might be scrutinized or judged negatively by others. Agoraphobia:Fear of open or crowded places.

Panic Disorder Panic Disorder: Recurrent experiencing of attacks of extreme anxiety in the absence of external stimuli that usually elicit anxiety. Attacks are acute and seem to come “out of the blue” but may become associated with certain cues over time. Strong physical symptoms: shortness of breath, heavy sweating, tremors, and pounding of the heart and lasts for a few minutes Investigators estimate that 1% to 4% of the adult population is affected by panic disorder at some point in their lives.

Panic Attack A sudden surge of mounting physiological arousal Occurs out of the blue or in response to a phobic situation Bodily symptoms: heart palpitations, tightening in the chest or shortness of breath, choking sensations, dizziness, faintness, sweating, trembling, shaking, and/or tingling in the hands and feet. Psychological reactions: feelings of unreality, intense desire to run away and fears of going crazy , dying, or doing something uncontrollable.

Development of a Panic Attack Phase 1 Initiating Circumstances (internal or external) Phase 2 Slight increase in unusual or unpleasant body symptoms (i.e heart palpitations, shortness of breath, etc.) Phase 3 Internalization (Increased focus on symptoms makes them more noticeable and easily magnified) Phase 4 Catastrophic Interpretation (telling yourself the symptom is dangerous – ie. “I’ll have a heart attack,” “I’ll go completely out of control”, “I must leave at once”) Phase 5 Panic

Generalized Anxiety Disorder Example (What About Bob): http://www.youtube.com/watchv=RfrueeBmfXo&feature=related (0-1:33) What did you notice? Disorder involving persistent feelings of worry accompanied by states of bodily tension and heightened arousal. The anxiety isnotfocused on a specific object, situation or activity, but more on basic fears such as fear of losing control, not being able to cope, failure, rejection or abandonment, and death and disease. Symptoms may include motor tension, autonomic overarousal, feelings of dread and foreboding and excessive worrying and vigilance. Unable to exercise control over worrying

Obsessive Compulsive Disorder Example (As Good As It Gets): http://www.youtube.com/watch?v=44DCWslbsNM&feature=PlayList&p=F2B05F841C319A34&playnext=1&playnext_from=PL&index=34 What did you notice? Obsessive-Compulsive Disorder: A disorder characterized by the presence of obsessions, compulsions or both. Obsession: A recurring thought or image that seems beyond one’s ability to control. Compulsion: An apparently irresistible urge to repeat an act or engage in ritualistic behavior such as hand washing.

Post Traumatic Stress Disorder and Acute Stress Disorder Example (Law and Order – SVU): http://www.youtube.com/watch?v=Ddi86i3vF6E&feature=PlayList&p=C460C4EF4209FF71&index=25 (0-1:20) What did you notice? Posttraumatic Stress Disorder (PTSD): A prolonged maladaptive reaction to a traumatic event that is characterized by intense fear, avoidance of stimuli associated with the event, and re-living of the event. Exposure to trauma in the form of physical attacks, combat, medical emergencies, accidents, terrorist attacks or witnessing a death can lead to PTSD. Acute Stress Disorder: Characterized by feelings of intense anxiety and feelings of helplessness during the first month following exposure to a traumatic event.

Group Activity: Break into groups In your group, determine which Anxiety Disorder your person has if any. What are the signs/symptoms they are experiencing?

Causal Factors of Anxiety Disorders Long-Term, Predisposing Causes ,[object Object]

Your parents communicate an overly cautious view of the world

Your parents are overly critical and set excessively high standards

Emotional insecurity and dependence

Your parents suppress your self-assertiveness

Biological CausesShort-term, triggering causes ,[object Object]

Stimulants and recreational drugs

Conditioning and the origin of phobias

Trauma, Simple phobias, and the post-traumatic stress disorder,[object Object]

Coun 106 final

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