Coun 106 final
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Coun 106 final
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- 12. Adapt
- 13. React appropriately to (a) situation(s)
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- 57. Childhood circumstances
- 58. Your parents communicate an overly cautious view of the world
- 59. Your parents are overly critical and set excessively high standards
- 60. Emotional insecurity and dependence
- 61. Your parents suppress your self-assertiveness
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- 63. Significant personal loss
- 64. Significant life change
- 65. Stimulants and recreational drugs
- 66. Conditioning and the origin of phobias
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- 68. Anxious self-talk
- 69. Mistaken beliefs
- 70. Withheld feelings
- 71. Lack of assertiveness
- 72. Lack of self-nurturing skills
- 73. Muscle tension
- 74. Stimulants and other dietary factors
- 75. High-stress lifestyle
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Hinweis der Redaktion
- Intro
- …Are all words we might use to describe someone who has a problem with anxiety. If someone has too much stress for too long anxiety is very often the result. This class is about stress, anxiety and anxiety disorder and will aim to help you…Next slide
- (slide)As we saw, anxiety results from too much stress for too long…so lets first visit what Stress is.Who has felt stress one point in your life?
- “The subject of stress has become a common topic of conversation. We often hear friends, classmates, coworkers, and family members talk about the problems they have in managing the stresses of everyday living. We say we feel "burned out," stressed out, overwhelmed, angry, irritable, depressed, anxious, and on the verge of "losing it.”Class brainstorm:(Refer to definition on slide)
- Before we explore the different ways stress manifests lets discuss the reaction: “fight or flight”What is it?(go over slide)Example of the caveman and tiger: “In the days of the cavemen, the fight or flight response was key to their survival. When faced with a threatening tiger, for instance, a caveman had two main choices. He could fight the tiger or he could run away. Either way, his body had to prepare quickly to respond. The caveman's heart began to race, his breathing rate increased, his pupils dilated, his muscles became tense, and his mind processed information rapidly. This natural response to danger helped the cavemen survive.”
- More common example that we can probably relate to is Public Speaking.Physical – What happens in your bodyBehavioral – what you doCognitive – How you thinkEmotional – how you feel“A more contemporary example of a situation that invokes the stress response for many people is public speaking. This may not be a life and death situation, but many of us perceive this situation as somewhat threatening. If you find public speaking to be stressful, you might notice certain physical, behavioral, mental, and emotional responses when you have to speak in front of a group of people.”“I have drawn a blank body on the board. What are the Physical, Behavioral, Cognitive, and Emotional signs of stress?”(Overview slide after students give feedback)
- Pass out hand out
- “We addressed one common stressor that people feel. What are your own stressors at this time in your life?”Pass out handout on stressors. Have students work on handout.Have students share.
- Experiencing some amount of stress in our lives is protective and adaptive. Our responses to stress help our minds and bodies to prepare for difficult challenges, and to react appropriately in a time of crisis. In fact, a certain amount of stress is necessary to help us perform at our best. Stress adds flavor, challenge and opportunity to life. Without stress, life could become quite dull and unexciting
- Distress - “It is the all encompassing sense of being imposed upon by difficulties with no light at the end of the tunnel.” (Refer to slide)
- “What do you think are some environmental factors that lead to stress?” (Refer to slide) “What do you think are some social factors that lead to stress?” (Refer to slide)
- “What do you think are some physiological factors that lead to stress?” (Refer to slide) “How do thoughts lead to stress?” (Refer to slide)
- Flip over other handout and on back will see, Vulnerability to Stress worksheet. Use note cards if needed. “Were any of you surprised with your results? Did any of you agree/disagree with your score/result? If so why or why not?” “Before we address how to cope and manage stress lets look at why we stress out.”
- “The interesting thing about stress is that it begins with our own perceptions of things!”Ex of perception:“If three of your friends all get a poor grade on a test, you might notice some different reactions. One friend may seem mildly annoyed for an hour or so. Another friend doesn't seem to be bothered at all. The third friend, however, might become quite alarmed by this poor grade. She can't get it off her mind, she vows to study three times as hard next time, she can't concentrate on her other work, and she might even find it difficult to fall asleep that evening. She might become increasingly concerned about all the grades she'll make this semester, and wonder whether her GPA will suffer.In a case such as this, a poor grade on a test means something different for each of your friends. The same situation has happened to all three, but each person feels more or less stressed about it because of what it means to him or her.”Irrational beliefs: “Example: A = losing a job, B = “This job was the most important thing in my life”, “What a no-good failure I am”, “My family will starve”, “I’ll never find a job as good”, “There’s nothing I can do about it”. These beliefs compound: C = misery and helplessness and divert from planning and deciding what to do next.”
- Develop awareness… Study the examples of irrational beliefs in Table 3.3 and ask yourself whether any of them rings true to you. Also pay attention to your thoughts when you feel anxious or frustrated.Accuracy of thoughts: Are they guiding you toward a solution or are they compounding your problems? D they reflect reality or do they blow things out of proportion? Do they misplace the blame for failure or short comings?Prepare thoughtsReward yourself.
- Later we will do an exercise to practice how to challenge irrational beliefs.
- Pass out irrational beliefs table handout
- Intro: “It is important for us to not only be aware of warning signals in our environment (external) such as events, but also the internal warning signals. We tend to ignore these internal warning signals and push ourselves harder, which just leads to more stress.” (Refer to slide) Pass out Stress Warning Signals worksheet.On the other side it the stress symptom checklist
- (Intro to slide): “To this point, you have identified specific stressors in your life, your degree of vulnerability to the negative effects of stress, and your stress warning signs. We've also addressed how our thoughts and perceptions impact how stressed we might feel. Now what?”“You may already have things you do to help yourself relieve stress. The following pages offer 12 more suggestions. Please consider each one carefully, and think about how you can incorporate it into your life.”Find a support system. Find someone to talk to about your feelings and experiences. Speak to friends, family, a teacher, a minister, or a counselor. Sometimes we just need to "vent" or get something "off our chest." Expressing our feelings can be relieving, we can feel supported by others, and it can help us work out our problems.2. Change your attitude. Find other ways to think about stressful situations. "Life is 10% what happens to us, and 90% how we react to it." Talk to yourself positively. Remember, "I can handle it, " "this will be over soon," or "I have handled difficult things before, and I can do it again." Also, practice acceptance. We need to learn to accept things we cannot change without trying to exert more control over them. 3. Be realistic. Set practical goals for dealing with situations and solving problems. Develop realistic expectations of yourself and others. Setting our expectations or goals high may seem like a useful way to push ourselves and get things done, but we may also set ourselves up for disappointment and continued stress. Find the courage to recognize your limits
- 4. Get organized and take charge. Being unorganized or engaging in poor planning often leads to frustration or crisis situations, which most always leads to feeling stressed. Plan your time, make a schedule, establish your priorities. Do this regularly until it becomes a productive habit. Take responsibility for your life. Be proactive. Problem solve and look for solutions rather than worry. 5. Take breaks, give yourself "me time." Learn that taking time to yourself for rejuvenation and relaxation is just as important as giving time to other activities. At minimum, take short breaks during your busy day. You might purposely schedule time in your day planner just for yourself so that you can recharge for all the other things you need to do. Learn your "red flags" for stress, and be willing to take time to do something about it.Take good care of yourself: Eat properly, get regular rest, keep a routine. Allow yourself to do something you enjoy each day. Paradoxically, the time we need to take care of ourselves the most, when we are stressed, is the time we do it the least. When we feel overwhelmed we tend to eat poorly, sleep less, stop exercising, and generally push ourselves harder. This can tax the immune system and cause us to become ill more easily. If we take good care of ourselves to begin with, we will be better prepared to manage stress and accomplish our tasks in the long run.
- Learn to say "no." Learn to pick and choose which things you will say "yes" to and which things you will not. Protect yourself by not allowing yourself to take on every request or opportunity that comes your way. It is okay to decline a request for a favor. Saying "no" does not mean you are bad, self-centered, or uncaring. Learn skills of assertiveness so that you can feel more confident and have effective ways of saying "no."Get regular exercise. Exercising regularly can help relieve some symptoms of depression and stress, and help us to maintain our health. Exercise can build confidence, self-esteem, and self-image. It is also a great way to take time for yourself, blow off steam, and release physical tension.Get a hobby, do something different. For a balanced lifestyle, play is as important as work. Leisure activities and hobbies can be very enjoyable and inspiring, and they can offer an added sense of accomplishment to our lives. Don't quickly dismiss new opportunities.
- Slow down. Know your limits and cut down on the number of things you try to do each day, particularly if you do not have enough time for them or for yourself. Be realistic about what you can accomplish effectively each day. Also, monitor your pace. Rushing through things can lead to mistakes or poor performance. Take the time you need to do a good job. Poorly done tasks can lead to added stress.Laugh, use humor. Do something fun and enjoyable such as seeing a funny movie, laughing with friends, reading a humorous book, or going to a comedy show.Learn to relax. Learn some relaxation exercises. Develop a regular relaxation routine. Try yoga, meditation, or some simple quiet time. Relaxation techniques are skills that need to be developed with patience and practice so that we can use them effectively during difficult times of stress later on.
- For this exercise I write on the board, one by one, a series of questions. I pause for a few minutes between each question so students have time to complete their responses. Each question illustrates a different type of cognitive therapy technique (interventions that also can be found in psychodynamic therapy).After we complete the exercise, we go back over the questions and discuss the intended purpose of that technique. 1. I often worry that I _________. (fill in the blank) I then say and write on the board, 2. If this worry of yours was indeed true, what does it mean to you and why does it bother you so much? Students then write their response. After they finish, I repeat the question, "If what you JUST wrote was indeed true, what does it mean to you and why does it bother you so much?" Once they finish writing, I AGAIN repeat the question, ""If what you JUST wrote was indeed true, what does it mean to you and why does it bother you so much?" Repeating this question helps uncover various layers or clusters of beliefs that may be "irrational," "faulty," or "pathogenic" (the term varying according to the specific theory). Next slide.I then say, "Look back over the various things you wrote so far and answer this question:"3. What's the worst thing that could possibly happen? What do you fear most of all? This question uncovers possible catastrophizing. 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?The first question attempts to stimulate more rational, realistic thinking. The second encourages cognitive adapting to the situation. I then say, "Look back over the worrisome thoughts that you have written about so far, and answer this question:" 5. What do I (perhaps "secretly") get out of thinking like this? How does it work to my advantage?This question encourages the student to look at what might be called the "secondary gain," "ambivalence," or "conflict" related to those worrisome beliefs. 6. Persuade a FriendHere I tell the students to carry on a dialogue - in writing - with a friend. "Pretend that your friend has some of the same worrisome beliefs that you do. Look back over the things you wrote for questions 1-3. Pick out one of those statements and write it down, as if your friend just said it. Now skip a line, and write a response to your friend's statement. In that reponse, be a compassionate, rational, and realistic thinker. After you write your response, skip a line and have your friend reply. Maybe your friend is a bit stuck in his/her thinking. Then skip a line, and respond again to your friend. Keep this conversation going for 10 lines or so.This exercise encourages students to identify with and develop the rational, compassionate side of themselves. 7. Positive imagery antedotesI ask the students to select three positive images, real memory or imagination, related to: confidence & strength in your life... safety and peacefulness in your life... love in your life...I ask them to see each one clearly. Once those images are established, I ask them to imagine a real or imaginary scene related to one of their negative thoughts. I tell them that when the time feels right, they should move from the negative image to the positive one that feels like the right antedote, then back again to the negative image, repeating the cycle until they feel comfortable ending the exercise with the positive image firmly in mind. 8. I accept myself even though I __________ (do not use the word "am")I tell the students to write this sentence 10 times! This encourages "adaptive self talk" and "positive (healthy) thinking." Telling the students not to use the word "am" bypasses the tendency towards global labelling of oneself ("I accept myself even though I am a failure") and encourages them instead to focus on specific traits or behaviors.
- I then say, "Look back over the various things you wrote so far and answer this question:”3. What's the worst thing that could possibly happen? What do you fear most of all? This question uncovers possible catastrophizing. 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?The first question attempts to stimulate more rational, realistic thinking. The second encourages cognitive adapting to the situation. I then say, "Look back over the worrisome thoughts that you have written about so far, and answer this question:" 5. What do I (perhaps "secretly") get out of thinking like this? How does it work to my advantage?This question encourages the student to look at what might be called the "secondary gain," "ambivalence," or "conflict" related to those worrisome beliefs.
- 6. Persuade a Friend Here I tell the students to carry on a dialogue - in writing - with a friend. "Pretend that your friend has some of the same worrisome beliefs that you do. Look back over the things you wrote for questions 1-3. Pick out one of those statements and write it down, as if your friend just said it. Now skip a line, and write a response to your friend's statement. In that reponse, be a compassionate, rational, and realistic thinker. After you write your response, skip a line and have your friend reply. Maybe your friend is a bit stuck in his/her thinking. Then skip a line, and respond again to your friend. Keep this conversation going for 10 lines or so.This exercise encourages students to identify with and develop the rational, compassionate side of themselves. 7. Positive imagery antedotesI ask the students to select three positive images, real memory or imagination, related to: confidence & strength in your life... safety and peacefulness in your life... love in your life...I ask them to see each one clearly. Once those images are established, I ask them to imagine a real or imaginary scene related to one of their negative thoughts. I tell them that when the time feels right, they should move from the negative image to the positive one that feels like the right antedote, then back again to the negative image, repeating the cycle until they feel comfortable ending the exercise with the positive image firmly in mind. 8. I accept myself even though I __________ (do not use the word "am")I tell the students to write this sentence 10 times! This encourages "adaptive self talk" and "positive (healthy) thinking." Telling the students not to use the word "am" bypasses the tendency towards global labelling of oneself ("I accept myself even though I am a failure") and encourages them instead to focus on specific traits or behaviors.
- 7. Positive imagery antedotesI ask the students to select three positive images, real memory or imagination, related to: confidence & strength in your life... safety and peacefulness in your life... love in your life...I ask them to see each one clearly. Once those images are established, I ask them to imagine a real or imaginary scene related to one of their negative thoughts. I tell them that when the time feels right, they should move from the negative image to the positive one that feels like the right antedote, then back again to the negative image, repeating the cycle until they feel comfortable ending the exercise with the positive image firmly in mind. 8. I accept myself even though I __________ (do not use the word "am")I tell the students to write this sentence 10 times! This encourages "adaptive self talk" and "positive (healthy) thinking." Telling the students not to use the word "am" bypasses the tendency towards global labeling of oneself ("I accept myself even though I am a failure") and encourages them instead to focus on specific traits or behaviors.
- Intro: “Relaxation techniques can help reduce emotional and physical sensations of stress, as well as the worry or stressful thoughts that may accompany them. If you can learn to relax your breathing and reduce your muscle tension, your mind will follow. Conversely, if you can learn to ease stressful thoughts and worry, your body will relax as well.”While there are numerous types of relaxation exercises, we will explore two of them here:
- 1. Students sit comfortably for this activity 2. Use a calm, low, slow voice and give sufficient time between each visual suggestion for students to “ease” into the vision and “see” each step Close your eyes. “See” in your mind’s eye a beautiful beach. The sun is shining warmly, the breeze coming from the ocean is soft and warm, palm trees are overhead and a few seagulls circle about. Imagine walking barefoot in the warm sand, feel your feet sink in the sand with each step. Walk toward the water’s edge and let the water roll over your feet. Jump inthe water; it is warm, gentle and very refreshing. Come out of the water and walk to your big beach towel, lay down and relax. Rest for a while in all the peace and beauty surrounding you. Imagine how it looks, how it sounds, how it smells. Breathe in deeply the warm ocean air, stay as long as you like. When you are ready to leave, go to the edge of the water and throw in anything that has been bothering you, anything you wish to be rid of in your life, anything you are feeling sad or angry about, anything you worry about (e.g. problems at home, violence in your neighborhood, bullies, death of a loved one, issues with friends). Picture it as a big rock, a chain, a heavy bag over your shoulders, or any image that helps you see it as undesirable. Throw it in the ocean as far as you can. Watch it sink and get taken by the waves. When the “visit” is done, be thankful for the release of the burden, the problem, the worry; then walk peacefully back through the warm sand and take a rest on your beach towel. It doesn’t have to be a beach. It can be any place to event where they felt calm and safe. Pass out handout on relaxation exercises. Sometimes these techniques won’t be able to help decrease anxiety. We will first identify when stress/anxiety becomes more intense
- Anxiety diary: For period of two weeks (or longer if you prefer) keep an hourly diary of your anxeity and activity level. Rate your anxiety from 0-10. Note down anything that seems important. Were you at work or home, who were you with, what were you doing, what were you thinking about? You may start to become more aware of situations that make you anxious or that you may even be avoiding. What is your general level of stress like? This information will help you begin to tackle your anxiety.If you become aware that you have a realistic worry or problem that you feel may be causing you anxiety, a problem solving approach may help. A good way to begin is to write down a problem. Define it as clearly as you can ex. “I never have money” is too vague, something like “I owe $5000 to different credit card companies”, is more helpful. Next write down as many possible solutions as you can. It doesn’t matter how silly. Try to think how you have solved similar problems in the past.Also look at handout, 24 positive coping strategies
- Anxiety disorders are distinguished from everyday, normal anxiety in that they involve anxiety that 1) is more intense (for example panic attacks), 2) lasts longer (anxiety that may persist for months instead of going away after a stressful situation has passed), or 3) leads to phobias that interfere with your life.
- Social Phobia- have fear of doing something that will be humiliating or embarrassing. Ex. Fear of public speakingImpact both social and occupational spaces. Agoraphobia – Fear of being in places where it might be difficult to escape or which help might not be available if they experience panicky symptoms. Often refuse to leave home.Example in book.
- Physical symptoms: Shortness of breath or a feeling of being smotheredHeart palpitations – pounding heart or accelerated heart rateDizziness, unsteadiness, or faintnessTrembling or shakingFeeling of chokingSweatingNausea or abdominal distressFeeling of unreality – as if you’re not all thereNumbness or tingling in hands and feetHot and cold flashesChest pain or discomfortFears of going crazy or losing control Fears of dyingDiagnosed with this if have 2 or more panic attacks
- Ways to address it: regular practice of deep relaxation, program of exercise, elimination of stimulants (caffeine, sugar, and nicotine) from your diet, learning to acknowledge and express your feelings, especially anger and sadness, adopting self-talk and “core beliefs” which promote a calmer and more accepting attitude toward life.
- Pass out panic attack record handout
- Generalized anxiety disorder is characterized by chronic anxiety that persists for at least six months but is unaccompanied by panic attacks, phobias, or obsessions. You simply experience persistent anxiety and worry without the complicating features of other anxiety disorders.
- Obsessions may occur by themselves without necessarily being accompanied by compulsions. In fact, about 25% of the people who suffer from obsessive-compulsive disorder only have obsession and these often center around fears of causing harm to a loved one.The most common compulsions include washing, checking, and counting. OCD is often accompanied by depression and phobic avoidance.
- PTSD may not begin for many months or years after the trauma, but it may last for years or even decades afterward.Anxiety related symptoms (rapid heart rate and feelings of anxiety and helplessness.Traumatic event is revisited in the form of intrusive memories, recurrent dreams ,and flashbacks. People try to avoid thoughts and activities connected to the trauma. Find it more difficult to enjoy life and may have sleep problems, irritable outbursts, difficulty concentrating, extreme vigilance, and an exaggerated “startle” response to sudden noise.
- Long-Term, Predisposing CausesHeredityChildhood circumstancesYour parents communicate an overly cautious view of the worldYour parents are overly critical and set excessively high standardsEmotional insecurity and dependenceYour parents suppress your self-assertivenessPass out family background questionnaire handout Biological CausesShort-term, triggering causesStressors that precipitate panic attacksSignificant personal lossSignificant life changeStimulants and recreational drugsPass out the Life events survey handoutConditioning and the origin of phobiasTrauma, Simple phobias, and the post-traumatic stress disorder
- Maintaining CausesAvoidance of Phobic situation Anxious self-talk – Internal monologue that is subtle that usually starts with “What if”. This self talk anticipates the worst before it even happens. This often can trigger panic attacks.Mistaken beliefs – Your negative self-talk comes from underlying mistaken beliefs about yourself, others, and “the way the world is.”Pass out mistaken beliefs handout Withheld feelings – Denying feelings of anger, frustration, sadness or even excitement can contribute to a state of free-floating anxiety. Free-floating anxiety is when you feel vaguely anxious without knowing why. Anxiety prone people are often born with a predisposition to be more emotionally reactive or volatile. Tend to grow up in families where obtaining parental approval takes precedence over expressing their needs and feelings. As adults they still feel it is more important to attain perfection or always be pleasing than to express strong feelings. Lack of assertivenessLack of self-nurturing skills – pervasive sense of insecurity. Unaware of how to love and nurture themselves, they suffer low self-esteem and may feel anxious or overwhelmed in the face of adult demands and responsibilities.Pass out affirmation handout and examples of affirmations handoutMuscle tension – when your muscles are tense, you feel “uptight”. Muscle tension tends to restrict your breathing. And when your breathing is shallow and restricted you are more likely to experience anxiety. Tense muscles also help to keep your feelings suppressed which can increase anxiety. When your body is tense, your mind has a greater tendency to race. Stimulants and other dietary factors – they can aggravate anxiety and leave you more vulnerable to panic attacks. High-stress lifestyle - Lack of meaning or sense of purpose
- 2 therapies that are most successful with Anxiety DisordersCognitive behavioral therapy: focuses on linking the relationship between your thoughts and perceptions and how it influences our behavior. We did some activities earlier. Behavior Therapy: Systematic application of the principles of learning to the direct modification of a client’s problem behaviors.Behavior therapists draw upon the principles of classical and operant conditioning as well as observational learning.What does that mean?It’s a therapy that uses manipulation of environment to modify person’s behaviors. Can add the cognitive component to help clients figure out how their thoughts impact their behaviors as well.
- Example of flooding: we learn through associations, so if we have a phobia it is because we associate the feared object or stimulus with something negative.if the patient suffered from arachnophobia, the therapist might lock them in a room full of spiders.[1] While the patient would initially be very anxious, the mind cannot stay anxious forever. When nothing bad happens the patient begins to calm down and so from that moment on associate a feeling of calm with the previously feared object.[1] Example of gradual exposure: Fear of elevators: 1) first stand outside the elevator, 2) stand outside with the door open, 3) taking the elevator down one floor, 4) then up one floor, 5) then down two floors, 6) etc. Examples of systematic desensitization:First taught relaxation skills.Once the individual has been taught these skills, he or she must use them to react towards and overcome situations in an established hierarchy of fears. The goal of this process is that an individual will learn to cope and overcome the fear in each step of the hierarchy, which will lead to overcoming the last step of the fear in the hierarchy.
- Retreat – simply exit the situation until your anxiety subsides. Its very important to distinguish retreat from escape in withdrawing from a phobic situation. Retreat means that you leave a situation temporarily with the intention of returning when you feel better. Escape only serves to reinforce your phobia.Talk to another person – talking to someone nearby will help you get your mind off your panic symptoms and anxious thoughts.Move around or engage in physical activity – this helps you dissipate the extra energy or adrenalin created by the fight-or-flight reaction.Stay in the present – focus on concrete objects around you in your immediate environment. In a grocery store you might look at the people standing around and your surroundings. Engage in a Simple Repetitive Activity-these can help distract your attention from your panic symptoms or anxiety-provoking thoughts. (ex. Snap a rubber band against your wrist, sing, count backward from 100 by 3).Do something that require focused concentration – These work well as distractors from worry but not really when feeling anxious or panicky. Read a good novel or magazine, solve puzzles, knit or sew, engage in card or board games, play a musical instrument, plan your day’s activitiesPaint or play with clayExpress Anger – anger and anxiety are incompatible reactions. If you can express anger physically onto an object – not just talk about it – at the moment you feel sensations of panic coming on, you often can abort the occurrence of a panic attack. (pound on a pillow or your bed with both fists, scream into a pillow or in your car alone with the windows rolled up, hit a punching bag.
- Experience something immediately pleasurablePractice abdominal breathing -