Anxiety and Anxiety Management COUN 106Marisa Mariano, MFT

Agenda8:30-8:45 Attendance/Intro8:45-10:30 Class10:30-10:45 Break10:45-12:00 Class12:00-1:00 Lunch1:00-3:00 Class3:00-3:15 Break3:15-4:15 Class4:15-4:30 Closing

“Bad with your nerves”“A worrier”

“Stressed out”“Unable to relax”

“Tense and nervous”

Objectives1. Recognize whether or not you may be

suffering from symptoms of anxiety2. Understand what stress, anxiety and

anxiety disorders are, what can cause it and what can keep it going.

3. Overcome your anxiety by learning better ways of coping with it.

What is Stress?Class brainstormStress 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

CognitiveEmotional

Signs of stressPhysical

Increased heart rateClammy or sweaty handsPhysically shaking Rapid and shallow breathingJaw tightensLight-headed

BehavioralStutteringLooking down a lotAvoid eye contact with the audienceAbsence on day of presentationRushing through presentation

Signs of stress (cont’)Cognitive

Your mind may go blankYour thoughts might race wildly. You might have thoughts about making a mistake or looking ridiculous in front of your peers.

EmotionalYou might feel

Very anxious FearfulResentful/AngryFrustrated

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:

•Learn to protect ourselves•Adapt•React appropriately to (a) situation(s)•Helps us perform our best•Adds flavor to our lives

Not All Stress is "Bad”

There are two types of stress:Distress is a continuous feeling of being:

Overwhelmed, Oppressed,Behind in our responsibilitiesExamples:

financial difficulties,conflicts in relationships,excessive obligations,managing a chronic illnessexperiencing a trauma

Eustress is a positive and beneficial form of stress.

May be challenging but sources of the stress are opportunities that are meaningful.Helps provide us with energy and motivation to meet our responsibilities and achieve our goals. Examples:

graduating from college, getting married,(+) Changes in our jobs

When stress and anxiety become a

problemWhen the symptoms are:

Severe and unpleasantGoing on too longHappening too oftenCausing us to worry that there is something serious wrongStopping us from doing what we want to do

What can lead to stress?

Stress generally comes from 4 main areas:•Environmental factors•Social Factors•Physiological Factors•Thoughts

Four main sources of stress:

Environmental Factors excessive noise,bad weather or natural disasters, traffic, pollution, problems with roommates or neighbors

Social Factorsdeadlines,financial problems,group projects,disagreements,demands on time and attention, dating, balancing work and school, loss of a loved one, conflicts with family

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

ThoughtsOur 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 stress75-90% of visits to a physician's office are for stress-related conditions and complaintsStress has been linked to the 6 leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicideIn 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 stressHow 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 CA – Activating EventB – BeliefsC – 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/miserableNext, 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

1. Find a support system.

2. Change your attitude. “Life is 10% what happens to us and 90% how

we react to it”.

3. Be realistic.

12 Suggestions for Reducing Stress

(continued)4. Get organized and take charge!

5. Take breaks, give yourself “me” time.

6. Take good care of yourself.

12 Suggestions for Reducing Stress

(continued)7. Learn to say “no”.

8. Get regular exercise.

9. Get a hobby, do something different.

12 Suggestions for Reducing Stress

(continued)10.Slow down.

11.Laugh, use humor.

12.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 statementNext 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 antedotesSelect 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 ExerciseAn example to relaxation exercises.

Discussion questionsWhere 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

anxietyAnxiety DiaryFor 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 stress2) lasts longer3) leads to phobias that interfere with life

Anxiety Disorders – criteria is established in the DSM-IV-TR

Anxiety Disorders

Types of Anxiety Disorders

PhobiasSpecific PhobiaSocial PhobiaAgoraphobia

Panic DisorderGeneralized Anxiety DisorderObsessive Compulsive DisorderPost-Traumatic Stress DisorderAcute Stress Disorder

PhobiasExample (Arachnophobia):

http://www.youtube.com/watch?v=5ksMw4MJgn0&feature=relatedWhat 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 DisorderPanic 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 minutesInvestigators estimate that 1% to 4% of the adult population is affected by panic disorder at some point in their lives.

Panic AttackA sudden surge of mounting physiological arousal Occurs out of the blue or in response to a phobic situationBodily 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 is not focused 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 groupsIn your group, determine which Anxiety Disorder your person has if any. What are the signs/symptoms they are experiencing?

Types of Anxiety Disorders

PhobiasSpecific PhobiaSocial PhobiaAgoraphobia

Panic DisorderGeneralized Anxiety DisorderObsessive Compulsive DisorderPost-Traumatic Stress DisorderAcute Stress Disorder

Causal Factors of Anxiety Disorders

Long-Term, Predisposing Causes• Heredity• Childhood circumstances

• 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 Causes

Short-term, triggering causes• Stressors that precipitate panic attacks

• Significant personal loss• Significant life change• Stimulants and recreational drugs

• Conditioning and the origin of phobias• Trauma, Simple phobias, and the post-traumatic stress disorder

Causal Factors of Anxiety Disorders

Maintaining Causes• Avoidance of Phobic situation• Anxious self-talk• Mistaken beliefs• Withheld feelings• Lack of assertiveness• Lack of self-nurturing skills• Muscle tension• Stimulants and other dietary factors• High-stress lifestyle• Lack of meaning or sense of purpose

Treatments for Anxiety Disorders

Cognitive Behavioral Therapy Behavioral Therapy

Fear Reduction MethodsFlooding: A person is exposed for prolonged intervals to a fear-evoking but harmless stimulus until fear is extinguished.Gradual exposure: Similar to flooding, but works upward in a hierarchy of progressively more fearful stimuli.Systematic Desensitization: method for reducing fears by associating a hierarchy of images of fear-evoking stimuli with deep muscle relaxation.Imagery Desensitization: Modeling: A technique in which a client observes and imitates a person who approaches and copes with feared objects or situations.

Imagery DesensitizationConstruct an appropriate hierarchyImagine having to deal with this situation in a very limited way – one that hardly bothers you at all.Now imaging what would be the strongest or most challenging scene relating to your phobia and place it at the opposite extreme as the highest step in your hierarchy. Now take some time to imagine six or more scenes of graduated intensity related to your phobia and rank them according to your anxiety provoking potential.

How to practice Imagery Desensitization

RelaxVisualize yourself in a peaceful sceneVisualize yourself in the first scene of your phobia hierarchy.If you experience mild to moderate anxiety (level 2 or 3 on the Anxiety Scale), spend 30 seconds to 1 minute in the scene, allowing yourself to relax to it.After a minute of exposure, retreat from the phobic scene to your peaceful scene.

How to practice Imagery Desensitization

If visualizing a particular scene causes you strong anxiety (level 4 or above on the Anxiety scale), do not spend more than 10 seconds there. – go to a peaceful place.Continue progressing up your hierarchy step by step in imagination.Use worksheet

Example of Real Life Gradual Exposure

Video with example of Behavioral Therapy – real life gradual exposure.From A&E show, “Obsessed”.http://www.aetv.com/obsessed/video/?bcpid=45697868001&bclid=23151005001&bctid=29322475001

Coping Strategies to Counteract Panic at an Early

StageRetreatTalk to another personMove around or engage in physical activityStay in the presentEngage in a simple repetitive activityDo something that requires focused concentrationExpress anger

Coping Strategies to Counteract Panic at an Early

StageExperience something immediately pleasurableVisualize a comforting person or scenePractice thought stoppingPractice abdominal breathingPractice muscle relaxationRepeat positive coping statementsUse breathing (or relaxation) in combination with coping statements

Books and other resourcesThe Anxiety and Phobia Workbook, by Bourne,

Edmund, Ph.D. Life After Stress, by Shaffer, MartinGuide to Stress Reduction, by Mason, JohnThe Relaxation and Stress Reduction Workbook, by Davis, MarthaManaging Anxiety, by Kennerley, HelenThe Feeling Good Handbook, by Burns, David.Self-help for Your Nerves, by Weeks, ClareFeel the Fear and Do it Anyway, by Jeffers, Susanhttp://www.wellnessproposals.com/mental-health/handouts/stress-management/anxiety-disorders.pdf

I’d like to leave you all with a song…Avenue

Q’s– “For Now” PRINCETON:Why does everything have to be so hard?GARY COLEMAN:Maybe you'll never find your purpose.CHRISTMAS EVE:Lots

of people don't.PRINCETON:But then- I don't know why I'm even alive!KATE MONSTER:Well, who does, really?Everyone's a little bit unsatisfied.BRIAN:Everyone goes 'round a little empty inside.GARY

COLEMAN:Take a breath,Look around,

Avenue Q – “For Now” BRIAN:Swallow your pride,KATE MONSTER:or now...BRIAN, KATE,

GARY, CHRISTMAS EVE:For now...NICKY:Nothing lasts,ROD:Life goes on,NICKY:Full of surprises.ROD: You'll be faced with problems of all

shapes and sizes.

Avenue Q – “For Now” CHRISTMAS EVE:You're going to have to make a few compromises...

For now...TREKKIE MONSTER:For now...ALL:But only for now! (For now)Only for now! (For now)Only for now! (For now)Only for now!

LUCY:For now we're healthy.BRIAN:For now we're employed.

Avenue Q – “For Now” BAD IDEA BEARS:For now we're happy...KATE

MONSTER:If not overjoyed.PRINCETON:And we'll accept the things we cannot avoid, for

now...GARY COLEMAN:For now...TREKKIE MONSTER:For now...KATE MONSTER:For now...

Avenue Q – “For Now” ALL:But only for now! (For now)Only for

now! (For now)Only for now! (For now)Only for now!Only for now!(For now

there's life!)Only for now!(For now there's love!)Only for now!(For now there's

work!)For now there's happiness!But only for now!(For now discomfort!)Only for

now!(For now there's friendship!)Only for now (For now!)Only for now!Only for

now! (Sex!)Is only for now! (Your hair!)Is only for now! (George Bush!)Is only for

now!

Avenue Q – “For Now” Don't stress,Relax,Let life roll off your backsExcept for death and

paying taxes,Everything in life is only for now!NICKY:Each time you smile...ALL:...Only for nowKATE MONSTER:It'll only last a while.ALL:

...Only for nowPRINCETON:Life may be scary...

Avenue Q – “For Now” ALL:...Only for nowBut it's only temporary

Ba-dum ba-dumBa-dum ba-dumBa dum ba-dumBa-da da da daba-da da-da da da-daBa-dum ba-da, ba-dum ba-daohhhh-PRINCETON:

Everything in life is only for now.